title: Effectiveness of Balloon Angioplasty in Children With Recurrent Aortic Coarctation Depends on the Type of Aortic Arch Pathology.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness of balloon angioplasty (BAP) for recurrent aortic coarctation (ReCoA) in infants comparing simple and complex type of aortic arch pathology (Norwood I procedure).
  
  
  BACKGROUND
  ReCoA is a known complication after cardiovascular surgery for coarctation of the aortic arch.
  
  
  RESULTS
  In a single center case study, we analyzed 20 infants undergoing BAP for ReCoA comparing simple (n = 10) and complex type of aortic arch pathology (n = 10). At catherization diameter of ReCoA stenosis was 3.2 ± 0.7 mm (mean ± SD) with short localized (11/20) or long hypoplastic stenosis (9/20) before and 4.8 ± 1.2 mm after BAP (P < 0.001). Invasive systolic pressure gradient was reduced from 27.5 ± 16.2 mmHg before to 5.1 ± 6.6 mmHg after BAP (P < 0.001), comparable in simple and complex type of ReCoA. At day 1 after catherization noninvasive systolic arterial blood pressure gradient was reduced from 20.2 ± 23.1 to 6.7 ± 9.9 mmHg (P < 0.001), respectively, calculated continuous wave Doppler echo gradient from 36.3 ± 22 to 16.8 ± 9.6 mmHg (P < 0.01). Complications were aortic arch dissection (1/20), discrete aortic arch aneurysm formation (1/20), pericardial effusion (1/20), and peripheral arterial thrombosis (4/20). At a mid-term follow up of 9.5 months (1-40) after BAP, 3 infants needed early surgical reintervention due to secondary ReCoA, all with long hypoplastic aortic arch segments, but simple type of aortic arch pathology.
  
  
  CONCLUSIONS
  At mid-term follow up, BAP remains an effective catheter intervention for ReCoA for infants with localized ReCoA, but not with long hypoplastic aortic arch segments, even in simple type of aortic arch pathology.
authors.affiliation: Division of Paediatric Cardiology, Paediatric Heart Center, University Children's Hospital Zurich, Switzerland.|Children's Research Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Herzog
authors.affiliation: Children's Research Center, University Children's Hospital Zürich, Switzerland.|Division of Congenital Cardiovascular Surgery, Paediatric Heart Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Hitendu
authors.initials: H
authors.lastname: Dave
authors.affiliation: Children's Research Center, University Children's Hospital Zürich, Switzerland.|Division of Congenital Cardiovascular Surgery, Paediatric Heart Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Schweiger
authors.affiliation: Children's Research Center, University Children's Hospital Zürich, Switzerland.|Division of Congenital Cardiovascular Surgery, Paediatric Heart Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.affiliation: Division of Paediatric Cardiology, Paediatric Heart Center, University Children's Hospital Zurich, Switzerland.|Children's Research Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Quandt
authors.affiliation: Division of Paediatric Cardiology, Paediatric Heart Center, University Children's Hospital Zurich, Switzerland.|Children's Research Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kretschmar
authors.affiliation: Division of Paediatric Cardiology, Paediatric Heart Center, University Children's Hospital Zurich, Switzerland.|Children's Research Center, University Children's Hospital Zürich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods*; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging; D001017:Aortic Coarctation / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D055502:Secondary Prevention / Q000379:methods*; D013557:Switzerland