Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation

Abstract

Background Optimal timing and mode of treatment for patients with aortic coarctation remains controversial, particularly when the degree of obstruction is mild. Surgery, balloon dilatation, and stent implantation have all proven effective in the treatment of moderate or severe obstruction. In this report, we describe the use of stents to treat coarctation in a heterogeneous population, including patients with relatively mild obstruction. Methods Retrospectively, we studied the results of stent implantation in 33 patients, children and young adults, who underwent catheterization for treatment of coarctation. Patients with isolated coarctation, as well as those with associated cardiac defects, were included. The median systolic pressure gradient of our patients was 25 mm Hg. Results Patients had an acute decrease in systolic blood pressure gradient (25 mm Hg to 5 mm Hg, P <.001) and an increase in lumen diameter (8 mm to 13 mm, P <.001). When 16 patients were recatheterized during the follow-up period, gradients remained decreased (30 mm Hg to 14 mm Hg, P <.001) compared with prestent values. Ventricular end-diastolic pressure, which was increased in 82% of patients at the time of initial catheterization, decreased from 17 mm Hg to 14 mm Hg (P =.002). Although the procedure was generally safe, serious complications did occur. Conclusions Stent implantation represents a therapeutic option that can safely and effectively reduce gradient in challenging patients with mild postoperative coarctation. Furthermore, our data suggest that aortic obstruction often coexists with ventricular diastolic dysfunction in these patients and that relief of obstruction may play a role in improvement of function. (Am Heart J 2000;139:1054-60.)