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CLINICAL STUDIES

Balloon angioplasty of native coarctation: clinical outcomes and predictors of success

Caroline Ovaert, MD^1,*, Brian W. McCrindle, MD, MPH, FRCPC, FACC^*, David Nykanen, MD, FRCPC^*, Cathy MacDonald, MD, Robert M. Freedom, MD, FRCPC, FACC^* and Lee N. Benson, MD, FRCPC, FACC, FSCAI

^* Department of Pediatrics, Division of Cardiology and the Variety Club Cardiac Catheterization Laboratories, Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada
Diagnostic Imaging, Division of Cardiology and the Variety Club Cardiac Catheterization Laboratories, Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada
Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada

Manuscript received February 28, 1999; revised manuscript received October 20, 1999, accepted December 2, 1999.

Reprint requests and correspondence: Dr. Lee N. Benson, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
benson{at}sickkids.on.ca

OBJECTIVES

We sought to investigate the clinical impact of balloon angioplasty for native coarctation of the aorta (CoA) and determine predictors of outcome.

BACKGROUND

Balloon dilation of native CoA remains controversial and more information on its long-term impact is required.

METHODS

Hemodynamic, angiographic and follow-up data on 69 children who underwent balloon angioplasty of native CoA between 1988 and 1996 were reviewed. Stretch, recoil and gain of CoA circumference and area were calculated and related to outcomes.

RESULTS

Initial systolic gradients (mean ± SD, 31 ± 12 mm Hg) fell by –74 ± 27% (p < 0.001), with an increase in mean CoA diameters of 128 ± 128% in the left anterior oblique and 124 ± 87% in the lateral views (p < 0.001). Two deaths occurred, one at the time of the procedure and one 23 months later, both as a result of an associated cardiomyopathy. Seven patients had residual gradients of >20 mm Hg. One patient developed an aneurysm, stable in follow-up, and four patients had mild dilation at the site of the angioplasty. Freedom from reintervention was 90% at one year and 87% at five years with follow-up ranging to 8.5 years. Factors significantly associated with decreased time to reintervention included: a higher gradient before dilation, a smaller percentage change in gradient after dilation, a small transverse arch and a greater stretch and gain, but not recoil.

CONCLUSION

Balloon dilation is a safe and efficient treatment of native CoA in children. Greater stretch and gain are factors significantly associated with reintervention, possibly related to altered elastic properties and vessel scarring.

Abbreviations and Acronyms   CoA = coarctation of the aorta   LAO = left anterior oblique   LAT = lateral   MRI = magnetic resonance imaging

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