Balloon angioplasty for aortic coarctation--report of a questionnaire survey by the Japanese Pediatric Interventional Cardiology Committee.

Abstract

The aim of this study was to analyze the results of a questionnaire survey regarding acute and late effects of balloon angioplasty for aortic coarctation in Japan. Considerable controversy still exists regarding the effectiveness and safety of balloon angioplasty in native coarctation. Moreover, little information about this mode of treatment is available from Japan. A questionnaire was sent to 55 Japanese institutions with pediatric cardiology units. A total of 208 patients from 35 institutions were reported and analyzed for indications for balloon angioplasty, acute and late results, and complications. Balloon angioplasty was performed in 56 patients with native coarctation (group I) and in 152 patients with postoperative recoarctation (group II). In group I, the pressure gradient across the coarcted site decreased significantly from 34 +/- 19 to 16 +/- 21 mmHg (p < 0.001), and the diameter of the coarcted site increased significantly from 3.7 +/- 1.7 to 6.0 +/- 2.5 mm (p < 0.001). In group II the pressure gradient significantly decreased from 41 +/- 20 to 15 +/- 15 mmHg (p < 0.001) and the diameter of the coarcted site significantly increased from 4.2 +/- 2.2 to 6.8 +/- 3.1 mm (p < 0.001). The restenosis rate was significantly higher in group I (19/41, 46%) than in group II (25/139, 18%) (p = 0.0006). Redilation was successfully performed in 27 of 29 of the patients with restenosis. Major complications included femoral pulse loss, transient bradycardia, and arrhythmia. No patient died of a cardiac event related to the procedure. The significant risk factors for late restenosis included type of coarctation, age under 4 months, balloon size used, pressure gradient and coarctation diameter before the procedure. Balloon angioplasty is a suitable treatment for aortic coarctation in both native coarctation and postoperative recoarctation. Restenosis was significant after initial balloon angioplasty in native coarctation but redilation was effective in most cases. The most significant risk group for restenosis is young children with native coarctation.