Intermediate and Long Term Follow Up of Balloon Angioplasty for Native Coarctation of the Aorta in Neonates and Infants

Abstract

Background: Balloon angioplasty (BA) became an alternative procedure for the management of CoA, which initially performed at 1983 (5). The effectiveness of BA for the management of native CoA remains controversial in neonates (less than one month) and infants under the first year of life, in spite of its acceptable morbidity and the reduced complication rates. This controversy was due to higher re-stenosis rate and the increased risk of aneurysm formation present with CHF, which might also increase the surgical risk. Objective: To study the intermediate and the long-standing effects of BA for native CoA in neonates and infants and to determine any predictive factors for the outcome. Patients and Method: Included in the study were all patient 12 days to 11 months referred for possible balloon dilation to our Ibn-Albaitar teaching hospital department of congenital cardiac intervention with evidence of discrete coarctation of aorta. The hemodynamic data, angiogram and clinical records of 63 patients were examined with follow up data from 2 to 138 months (median 72 months). Results: Immediate success with balloon angioplasty was achieved in 35 Patients of 63 patients. 33 patients (52 %) with intermediate follow up data ( rang 12 to 138 months ) available are asymptomatic and normotensive with insignificant arm to leg blood pressure gradient (is lellss than 20 mmHg). 28 patients (44.4%) with primary successful result showed increase in gradient at 2 to 86 months after angioplasty requiring re-intervention in 28 Patients. Follow up after 84 months was available in 55 patients, 92% of whom are normotensive and have not required additional intervention. No additional intervention was needed in our patients > 7 years old. 17 of 29 surviving neonates who initially had a successful dilatation required re-angioplasty or operation after angioplasty. Transverse arch hypoplasia showed negligible effect on blood pressure gradient; whereas isthmus hypoplasia is linked with re-intervention in 14 % of patients. A small aneurysm was noted in 1 (1.5%) patients of 63 Patients. Conclusion: BA of native CoA is effective in neonates, infants under the first year of life, and also in the older children, the aneurysm formation is rare, and however life time follow up is reasonable.