Aortic obstructions in infants and children: Balloon dilatation for aortic coarctation

Abstract

This review describes the history, technique, and results of balloon angioplasty in the treatment of native and recurrent aortic coarctation in infants and children. The results of angioplasty are compared to those obtained with several surgical techniques. In 24 children treated for recoarctation, the mean peak systolic pressure difference across the obstruction was reduced from 40.3 ± 17.4 mm Hg before angioplasty to 8.5 ± 8.3 mm Hg immediately afterward and 7.5 ± 7.5 mm Hg at an average 54-month follow-up review. In children and older infants, the procedure is successful as demonstrated in several series by acceptable relief of obstruction (residual pressure difference <20 mm Hg) in 70% to 100%, with subsequent restenosis in 20%. In neonates with native aortic coarctation, angioplasty is often unsuccessful and associated with high rates of restenosis. Complications of the procedure include aortic aneurysm, dissection and rupture, cerebrovoscular accident, femoral arterial injury, paradoxical hypertension, and death. The early results of balloon angioplasty for aortic coarctation indicate that the procedure is as safe and effective as surgery for the treatment of recoarctation in children. In children and older infants with native coarctation, the procedure is a less invasive and less costly alternative to surgery. In neonates, angioplasty is much less effective and should be considered as a palliative alternative to surgery.