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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults

Mohamed Eid Fawzy, MD, FRCP (Lond), FACC, FESC^*,*, Mahmoud Awad, MD^*, Walid Hassan, MD, FACC^*, Yusuf Al Kadhi, MBBS, DABR, Mohamed Shoukri, PhD and Fadel Fadley, FRCPC^*

^* Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Department of Biostatistics, Clinical Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Manuscript received July 9, 2003; revised manuscript received September 6, 2003, accepted October 6, 2003.

^* Reprint requests and correspondence: Dr. Mohamed Eid Fawzy, Department of Cardiovascular Diseases (MBC-16), King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia.
robosa{at}kfshrc.edu.sa

OBJECTIVES: This study evaluated the long-term follow-up results of balloon angioplasty (BA) in adolescent and adult patients with discrete coarctation of the aorta.

BACKGROUND: Although the immediate and intermediate term results of BA for patients with aortic coarctation (AC) have been encouraging, there is a paucity of data on long-term follow-up results.

METHODS: This basis of this study was follow-up of 49 patients (mean age, 22 ± 7 years) undergoing BA for discrete AC at median interval of 10.2 years, including cardiac catheterization, magnetic resonance imaging, and Doppler echocardiography.

RESULTS: No early or late deaths occurred. Balloon angioplasty produced a reduction in peak AC gradient from 66 ± 23 mm Hg (95% confidence interval [CI]: 59.5 to 72.7) to 10.8 ± 7 mm Hg (95% CI: 8.8 to 12.5) (p < 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 ± 6 mm Hg (95% CI: 4.4 to 7.9) (p < 0.001). Four patients (7.5%) with suboptimal initial outcome with peak gradient >20 mm Hg had successful repeat angioplasty. Aneurysm developed at the site of dilation in four patients (7.5%). Magnetic resonance imaging follow-up results revealed no new aneurysm or appreciable changes in the size of pre-existing aneurysms, and no recoarctation was observed. Also, no appreciable changes in the Doppler gradient across the AC site were noted. The blood pressure had normalized without medication in 31 (63%) of the 49 patients.

CONCLUSIONS: Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease.

Abbreviations and Acronyms   AC = aortic coarctation   BA = balloon angioplasty   BP = blood pressure   CI = confidence interval   MRI = magnetic resonance imaging

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