Causes of recoarctation after balloon angioplasty of unoperated aortic coarctation

Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

During the 35 month period ending December 1987, 30 children, aged 14 days to 13 years, underwent balloon angioplasty of unoperated aortic coarctation with resultant reduction in coarctation gradient from 43.6 +/- 20.4 to 9.5 +/- 7.6 mm Hg (p less than 0.001). None of the patients required immediate surgical intervention. On the basis of results of 6 to 30 month follow-up catheterization data in 20 children, the patients were classified as follows: Group A, 13 patients with good results (gradient less than or equal to 20 mm Hg and no recoarctation on angiograms) and Group B, 7 patients with fair or poor results (gradient greater than 21 mm Hg with or without recoarctation on angiography). No patient developed aortic aneurysm at the site of angioplasty. Thirty variables were examined by multivariate logistic regression analysis and four factors were identified as risk factors for development of recoarctation: 1) age less than 12 months, 2) aortic isthmus less than 2/3 the size of the ascending aorta immediately proximal to the right innominate artery, 3) coarcted aortic segment less than 3.5 mm before dilation, and 4) coarcted aortic segment less than 6 mm after angioplasty. The identification of risk factors may help in selection of patients for balloon angioplasty. Avoiding or minimizing the number of risk factors may help reduce the chance of recoarctation after angioplasty. The intermediate-term follow-up results with regard to recoarctation are comparable with those after surgical repair of coarctation. Recoarctation after angioplasty was dealt with by repeat balloon angioplasty or surgical resection for those requiring treatment and clinical follow-up for the remaining children.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				M. A. Hamdan, S. Maheshwari, J. T. Fahey, and W. E. Hellenbrand Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1518 - 1523. [Abstract] [Full Text] [PDF]

				D A Harrison, P R McLaughlin, C Lazzam, M Connelly, and L N Benson Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up Heart, May 1, 2001; 85(5): 561 - 566. [Abstract] [Full Text]

				C. Ovaert, B. W. McCrindle, D. Nykanen, C. MacDonald, R. M. Freedom, and L. N. Benson Balloon angioplasty of native coarctation: clinical outcomes and predictors of success J. Am. Coll. Cardiol., March 15, 2000; 35(4): 988 - 996. [Abstract] [Full Text] [PDF]

				S. Maheshwari, E. Bruckheimer, J. T. Fahey, and W. E. Hellenbrand Balloon angioplasty of postsurgical recoarctation in infants: The risk of restenosis and long-term follow-up J. Am. Coll. Cardiol., January 1, 2000; 35(1): 209 - 213. [Abstract] [Full Text] [PDF]

				P S Rao and B Waterman Relation of biophysical response of coarcted aortic segment to balloon dilatation with development of recoarctation following balloon angioplasty of native coarctation Heart, April 1, 1998; 79(4): 407 - 411. [Abstract] [Full Text]

				S. F. Kaine, E. O'Brian Smith, A. R. Mott, C. E. Mullins, and T. Geva Quantitative Echocardiographic Analysis of the Aortic Arch Predicts Outcome of Balloon Angioplasty of Native Coarctation of the Aorta Circulation, September 1, 1996; 94(5): 1056 - 1062. [Abstract] [Full Text]

				S. Conte, F. Lacour-Gayet, A. Serraf, M. Sousa-Uva, J. Bruniaux, A. Touchot, C. Planche, and S. b. A. Castaneda Surgical management of neonatal coarctation J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 663 - 675. [Abstract] [Full Text]