CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Impact of Re-Coarctation Following the Norwood Operation on Survival in the Balloon Angioplasty Era
Ilana Zeltser, MD*,
Jondavid Menteer, MD ,
J. William Gaynor, MD,
Thomas L. Spray, MD,
Bernard J. Clark, MD, FACC*,
Jacqueline Kreutzer, MD, FACC* and
Jonathan J. Rome, MD, FACC*,*
* Division of Cardiology, The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Manuscript received June 17, 2004;
revised manuscript received August 10, 2004,
accepted January 4, 2005.
* Reprint requests and correspondence: Dr. Jonathan J. Rome, Division of Cardiology, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, Pennsylvania 19104. (Email: rome{at}email.chop.edu).
OBJECTIVES: The objective of this study was to determine the efficacy of balloon angioplasty (BA) by comparing the immediate and long-term outcomes of patients with and without re-coarctation after a Norwood procedure.
BACKGROUND: Although BA has become the standard means for treating recurrent coarctation following a Norwood operation, it has been suggested that re-coarctation remains a significant cause of morbidity and mortality.
METHODS: Patients who survived a Norwood operation from December 1986 through June 2001 were studied. Differences between groups were evaluated by t test and logistic regression. Survival differences were tested by log-rank tests using Kaplan-Meier survival curves.
RESULTS: Fifty-eight of 633 patients underwent treatment for re-coarctation (9.2%). Thirty-five patients underwent BA (before 1988, 23 had surgery). Median age at catheterization was 6.6 months (1.9 to 35.6 months). Balloon angioplasty was successful (gradient <10 mm Hg) in 32 of 35 patients (92%). There were no BA-related deaths or neurologic complications. Recurrent obstruction after BA occurred in seven patients (20%); five underwent re-dilation. Kaplan-Meier estimates of freedom from recurrent obstruction after initial BA were 97% at one month, 79% at one year, and 79% at five years. There were no differences in survival between patients with re-coarctation treated by BA and patients who did not undergo treatment for re-coarctation.
CONCLUSIONS: We found that 9.2% of patients underwent treatment for re-coarctation following a Norwood operation. Balloon angioplasty is effective, with low morbidity, no early mortality, and no difference in long-term survival when compared with patients who did not have re-coarctation. Recurrent coarctation following BA occurred in 17% of patients, usually within the first year after BA.
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Abbreviations and Acronyms
| | BA = balloon angioplasty | | HLHS = hypoplastic left heart syndrome |
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