Balloon dilation angioplasty of postoperative aortic obstructions

Abstract

Balloon dilation angioplasty (BDA) was attempted 29 times in 27 patients, aged 3 months to 22 years, with postoperative aortic obstructions. Previous operations included end-to-end anastomosis (n = 10), subclavian flap angioplasty (n = 7) and patch angioplasty (n = 3) for aortic coarctation, end-to-end anastomosis for interrupted aortic arch type B (n = 4) and aortic arch reconstruction for hypoplastic left heart syndrome (n = 3). Two of the patients with interrupted arch had multiple areas of obstruction. Balloon sizes were between 2 and 6 times the diameter of the lesion and up to twice the diameter of the proximal transverse arch (mean 1.1). BDA was at least partially successful (more than 50% decrease in gradient and more than 30% increase in diameter) in 26 of the 29 procedures (90%). BDA failed in the 2 lesions with an initial diameter of more than 8 mm. No differences were apparent In the success rate among any of the clinical groups. Peak systolic gradient decreased from 42 ± 14 to 14 ± 15 mm Hg (p < 0.01) and mean diameter increased from 4.1 ± 2.6 to 6.8 ± 3.2 mm (p <0.01). There was no mortality or significant acute morbidity associated with the procedure. After 1 to 24 months of follow-up, restenosis has occurred in only 1 patient. Aneurysm formation was found in 2 of 5 patients who had undergone repeat catheterization; both aneurysms occurred in patients with repaired interruption of the aortic arch. Thus, BDA can be both safe and effective in acutely relieving the gradient and stenosis in most forms of postoperative aortic obstruction. The incidence and significance of late recurrence (more than 2 years) or aortic aneurysms is unknown; these potential complications must be evaluated In every patient after BDA.