Percutaneous treatment of neonatal aortic coarctation presenting with severe left ventricular dysfunction as a bridge to surgery.
BACKGROUND
Neonatal aortic coarctation presenting with multiorgan failure is a life threatening condition.


OBJECTIVE
Our aim was to investigate whether emergency balloon dilation improved the prognosis of neonates with aortic coarctation who present with multiorgan failure.


METHODS
We studied all neonates referred over a period of 6 years with aortic coarctation and left ventricular dysfunction, with or without multiorgan failure. During the first half of the period, from January, 2001 to December, 2003, patients were treated surgically after regression of the multiorgan failure. During the second half, from January, 2004, to January, 2007, patients not responding to medical management were referred for balloon dilation of the coarcted segment.


RESULTS
Among 113 and 181 neonates, respectively, treated during the 2 periods, 40 and 36 had left ventricular dysfunction (p less than 0.01), and 11 and 23 had multiorgan failure (p less than 0.01). Prior to 2004, 6 deaths occurred before surgery. After 2004, 3 out of 14 patients (21%) treated by balloon angioplasty died in consequence of the procedure.During the period of the study, the global mortality of patients with left ventricular dysfunction diminished from 17.5 to 13.8%, this difference not being statistically significant. Mortality due to multiorgan failure, however, diminished from 54 to 13% (p less than 0.01). Multiorgan failure was reversed under medical treatment in 45% of patients, but in 87% under the regime of medical combined with interventional treatment (p less than 0.01).


CONCLUSIONS
To the best of our knowledge, this is the first series of neonates with aortic coarctation and multiorgan failure receiving a palliative treatment by balloon dilation. Although the prognosis of this condition remains severe, emergency balloon dilation can diminish mortality, providing a bridge to surgery in severely ill patients.
Bouzguenda
Ivan
I
Centre de Réference des Malformations Congénitales Complexes M3C, Université Paris V, Necker Enfants Malades, 149 rue de Sèvres, Paris, France.
Marini
Davide
D
Ou
Phalla
P
Boudjemline
Younes
Y
Bonnet
Damien
D
Agnoletti
Gabriella
G