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CLINICAL STUDIES

Balloon angioplasty of postsurgical recoarctation in infants

The risk of restenosis and long-term follow-up

^a Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut., USA The study was performed in compliance with regulations of the Human Investigation Committee of our institution. As this was a retrospective study, data regarding patient’s clinical status were collected by chart review. No tests were performed on any of the subjects as part of the study protocol. Patient confidentiality was maintained during data analysis and manuscript preparation

Manuscript received December 28, 1998; revised manuscript received August 9, 1999, accepted October 5, 1999.

Reprint requests and correspondence: Dr. William E. Hellenbrand, Section of Pediatric Cardiology, 333 Cedar Street, Yale–New Haven Hospital, New Haven, Connecticut 06520.
william.hellenbrand{at}yale.edu

OBJECTIVES

This study was undertaken to evaluate the long-term results of balloon angioplasty (BA) for postsurgical recoarctation in infants.

BACKGROUND

Balloon angioplasty is a well-accepted modality for the treatment of recoarctation. However, infants remain a group of concern because of their size, risk for complications and the potential for restenosis with growth. Age <12 months has been determined to be a risk factor for the development of recoarctation after angioplasty for native coarctation. Although studies on postsurgical coarctation have found no relationship between age at angioplasty and the development of recoarctation, few studies specifically addressing infants have been performed.

METHODS

Clinical, echocardiographic, hemodynamic and angiographic data on 22 consecutive children <1 year of age who underwent BA between 1986 and 1996 were reviewed.

RESULTS

A successful result, defined as a postprocedure gradient of 20 mm Hg, was achieved in 20 of 22 (91%) infants with a reduction in the systolic peak pressure gradient from 48 ± 27 to 9 ± 10 mm Hg (p < 0.001) and an increase in coarctation diameter from 2.7 ± 1.1 to 5.2 ± 1.5 mm (p < 0.001). At long-term follow-up of a median of 56 months (0.6 to 12 years), the restenosis rate after an initial optimal result was 16% (3 of 19). Five (24%) infants required reintervention (2 initially unsuccessful; 3 recoarctation), with a success rate of 95% after two procedures. Suboptimal long-term outcome correlated with a lower infant weight.

CONCLUSIONS

Balloon angioplasty can be safely performed in infants, with good long-term results. The risk of restenosis is low and can be successfully managed with repeat angioplasty.

Abbreviations and Acronyms   AAo = ascending aorta   BA = balloon angioplasty   CoA = coarctation   DAo = descending aorta

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