[Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results].
OBJECTIVE
The use of the balloon angioplasty (BA) in the treatment of patients with native aortic coarctation during childhood, particularly during the first 12 months of age, is controversial. The aim of this study was to report our experience with the use of this therapeutic technique and review the immediate and middle-term results in patients until 12 months age with native aortic coarctation and to identify those factors related with the outcome.


METHODS
We review retrospectively the clinical records of 35 patients less than 12 months of age with diagnosis of native aortic coarctation who underwent balloon angioplasty as first choice treatment during an eight year span (1998-2005). Total population was divided in two groups: group A patients < or = 3 months of age (n = 19) and group B patients between 4-12 months of age (n = 16).


RESULTS
Mean age at the time of balloon angioplasty was 4.3 +/- 3.3 months (range 0.7-12 months) and the mean body weight was 5.5 +/- 1.7 kg (range 2.6-10 kg). Initial result after BA was successful in 30 of 35 patients (85.8%) with a peak residual pressure gradient < or = 20 mm Hg. Successful result were obtained in 15 of 19 patients in group A (78.9%) and in 15 of 16 patients in group B (93.8%). The mean peak residual pressure gradient change from 46.9 +/- 20.3 mm Hg to 11.6 +/- 8.1 mmHg (p < 0.001) and the maximal coarctation diameter increase from 3.0 +/- 1.6 mm to 6.0 +/- 1.8 mm after BA in the group total. We did not observe deaths related to the procedure. On the follow-up recoarctation was observed in 17/35 patients (48.6%) 13 of them in group A (68.4%) and 4 in group B (25%). Ten patients with recoarctation underwent immediate surgical correction (9 in group A) while the other 7 underwent a second BA procedure (4 in group A). At the end of the study period AB was effective in 23 of 35 patients (65.7%), 9 of them in group A (47.3%) and 14 in group B (87.5%). The incidence of complications following BA was higher in group A (21%) than for group B (12.5%). Incidence of aneurysms was 15.8% for group A and 18.8% for group B (3 patients in each group).


CONCLUSIONS
Balloon angioplasty is a safe and effective alternative treatment for native aortic coarctation, even during the neonatal period. Due to the high incidence of aneurysm formation in children less than 1 year of age, a better selection of patients, the use of low-profile balloons and optimal postoperative care is mandatory to improve the final outcome and decrease the incidence of complications. A second balloon angioplasty procedure might improve the final outcome.
Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Servicio de Cardiología y Hemodinámica Pediátrica, México. rafaelparrabravo@yahoo.com.mx
José Rafael
JR
Parra-Bravo
Martín
M
Reséndiz-Balderas
Ramona
R
Francisco-Candelario
Heladia
H
García
Miguel Alejandro
MA
Chávez-Fernández
Luisa G
LG
Beirana-Palencia
José Luis
JL
Acosta-Valdez
María de Jesús
Mde J
Estrada-Loza
José Vicente
JV
Estrada Flores
D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000628:therapy*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome