Intraoperative balloon angioplasty of aortic coarctation in infants with hypoplastic left heart syndrome

Abstract

During a 1-year period, 9 children, aged 3 to 18 months, underwent intraoperative transluminal balloon angioplasty of coarctation of the aorta. Each patient had previously undergone palliative surgery for hypoplastic left heart syndrome. In 1 patient the angioplasty catheter was introduced into the ascending aorta during surgery to correct Intracardiac defects. In the other 8 infants the catheters were inserted directly into the descending thoracic aorta via thoracotomy because the catheter size precluded percutaneous insertion into the femoral artery. In each case, after measuring the systolic pressure gradient across the coarctation, the angioplasty catheters were advanced over the guidewire across the coarctation site. The balloons were then inflated 2 to 3 times with an internal pressure of 3 to 6 atm. After the dilation sequence the angioplasty catheters were removed and the pressures were again measured above and below the coarctation. Preoperative gradients across the coarctation site ranged from 26 to 85 mm Hg (mean 45). Immediately after the procedure the gradient decreased in each case, ranging from 0 to 12 mm Hg (mean 4.3). There were no signs of disruption of the aortic wall. Relief of the pressure gradient persisted in the 7 patients who underwent follow-up cardiac catheterization after the procedure. The patients have been followed for as long as 18 months after the procedure and none has shown physical or echocardiographic evidence of recurrent aortic obstruction. The method of introducing an angioplasty catheter directly into the aorta may greatly simplify treatment of coarctation of the aorta for patients in whom other intracardlac defects require repair and in small infants who are poor candidates for percutaneous transluminal aortic angioplasty.