Coarctation Of Aorta In Infants Research Articles

Results of the multicenter early feasibility study (EFS) of the Renata Minima stent as treatment for branch pulmonary artery stenosis and coarctation of aorta in infants.

Stent implantation has become standard of care in older children and adults for treatment of branch pulmonary artery stenosis (BPAS) and coarctation aorta (CoAo). There are no stents approved or available for infants that have the potential to be dilated to adult diameters. The Minima stent was designed to fulfill this unmet need. Multicenter, prospective, nonrandomized early feasibility studyevaluating safety and effectiveness of the Minima stent for treatment of BPAS and CoAo. Primary endpoints included: (1) successful deployment across lesion, (2) stenosis relief defined by an increase in angiographic diameter of >50% and (3) freedom from stent explant, embolization or migration at 30 days and 6 months. Between 2/2022 and 5/2022, 10 pts underwent Minima stent implantation with a median age and weight of 9 months (4-43 months) and 7.6 kg (5.1-16.9 kg). Procedural success and predefined stenosis relief was achieved in all cases (CoAo [n = 4], BPAS [n = 6]). Adverse events occurred in 3 pts: transient diminished lower extremity pulse (n = 2), distal stent on-balloon displacement successfully managed in the catheterization suite (n = 1). There were no deaths or major adverse events. All patients were free from stent explant and migration at 30 days and 6 months with no evidence for significant restenosis at latest follow-up. Implantation of the Renata Minima stent was safe and effective for the treatment of BPAS and CoAo in this small cohort of infants and young children during early follow-up. Based on these early results, an expanded study with longer follow-up is warranted.

Late Outcomes of Transcatheter Coarctation Intervention in Infants with Biventricular Anatomy.

Determine outcomes of catheter intervention for aortic coarctation in infants. Aortic coarctation in infants following surgical repair and in high surgical risk native cases remains a challenging problem. Catheter intervention is an alternative to surgical intervention. Single-center, chart review of infants with biventricular anatomy who underwent coarctation stent placement or balloon angioplasty between 04/2004 and 04/2020. Outcomes of interest included change in aortic lumen diameter, peak gradient, number of re-interventions, time to re-intervention, and adverse events. Thirty-four patients were included in analysis, of those 16 underwent stent placement. Patients' mean age was 4.0 ± 3.0months and weight of 5.3 ± 1.9kg. Follow-up interval was 5.4 ± 5.1years (0.2-16.1years). Twelve (35%) patients underwent procedure due to ventricular dysfunction; the rest were for high resting gradient. Coarctation diameter increased from 2.4 ± 1.0 to 4.5 ± 1.3 (p < 0.01) and gradient decreased from 32.0 ± 18.4mmHg to 9.2 ± 8.8mmHg (p < 0.01). Thirteen (81%) of the stented patients required at least one re-intervention, at an average of 1.7 ± 3.2years from the index procedure. Five (28%) of those undergoing balloon angioplasty required repeat intervention. There was no mortality due to the procedure and one late mortality. One patient had a serious procedural adverse event. On follow-up, 12 (35%) were on anti-hypertensive medications. Catheter intervention, including stent placement, for aortic coarctation in infants is feasible with an acceptable adverse event profile. Repeat interventions are common.

The immediate and late results for balloon angioplasty of native coarctation of aorta in pediatrics age group

Background: percutaneous balloon dilation of corotation of aorta is a less invasive and alternative to surgical repair for patients with discrete coaction of aorta and although the used of balloon angioplasty in patients with recurrent postoperative coarctation gained a wide consensus, the use this technique for native coarctation is still controversial in children less one years. &#x0D; Objective: to evaluate the immediate and late result of balloon dilation of native coarctation of aorta in infant and children.&#x0D; Type of the study: A prospective study. &#x0D; Subjects &amp; Methods: The study was done on forty-five patients who were referred for cardiac catheterization and balloon angioplasty of native coarctation of the aorta at Ibn-AL-Bitar center for cardiac surgery between January 2015 to May 2016.Left heart catheterization was performed with evaluation of the morphology and pressure gradient across the stenotic segment of aorta. Follow up evaluations were done between 1 week and 18 months after discharge (mean 6 months) with transthoracic echocardiography. &#x0D; Results: The age of patients range from 1month to 4 years (median age at time of procedure was12.3month). Associated lesions in 11 patients (24.4%). Immediate results were reduction in gradient from 42.5± 17.3 to 10.3± 8.2 mm Hg in forty-two patients (93.3%). Late result during follow up period, 29 patients (69%) had maintain gradient less than 20mmHg. Complications were reported in 6 patients (13.3%). there was one procedure related death (2.2%). &#x0D; Conclusions: Balloon angioplasty for treatment of native coarctation of the aorta is effective with sustained benefit on long-term follow-up in infants and children &gt;6 months. Transverse arch hypoplasia and children &lt;6 months old has major effect on late outcome of recurrent coarctation of aorta.

Evaluating the severity of aortic coarctation in infants using anatomic features measured on CTA.

A machine learning model was developed to evaluate the severity of aortic coarctation (CoA) in infants based on anatomical features measured on CTA. In total, 239 infant patients undergoing both thorax CTA and echocardiography were retrospectively reviewed. The patients were assigned to either mild or severe CoA group based on their pressure gradient on echocardiography. They were further divided into patent ductus arteriosus (PDA) and non-PDA groups. The anatomical features were measured on double-oblique multiplanar reconstructed CTA images. Then, the optimal features were identified by using the Boruta algorithm. Subsequently, the coarctation severity was classified using linear discriminant analysis (LDA). We further investigated the relationship between the anatomical features and re-coarctation using Cox regression. Four anatomical features showed significant differences between the mild and severe CoA groups, including the smallest aortic cross-sectional area indexed to body surface area (p < 0.001), the narrowest aortic diameter (CoA diameter) indexed to height (p < 0.001), the diameter of the descending aorta at the diaphragmatic level (p < 0.001) and weight (p = 0.005). With these features, accuracy of 88.6% and 90.2%, sensitivity of 65.0% and 72.1%, and specificity of 92.9% and 100% were obtained for classifying the CoA severity in the non-PDA and PDA groups, respectively. Moreover, CoA diameter indexed to weight was associated with the risk of re-coarctation. CoA severity can be evaluated by using LDA with anatomical features. When quantifying the severity of CoA and risk of re-coarctation, both anatomical alternations at the CoA site and the growth of the patients need to be considered. • CTA is routinely ordered for infants with coarctation of the aorta; however, whether anatomical variations observed with CTA could be used to assess the severity of CoA remains unknown. • Using the diameter and area of the coarctation site adjusted to body growth as features, the LDA model achieved an accuracy of 88.6% and 90.2% in differentiating between the mild and severe CoA patients in the non-PDA group and PDA group, respectively. • The narrowest aortic diameter (CoA diameter) indexed to weight has a hazard ratio of 10.29 for re-coarctation.

Cellular/intercellular interrelations in various parts of aorta after reconstructive treatment of aortic stenosis in infants

Aim. The article focuses on the evaluation of cellular/intercellular relationships in various parts of the aorta after reconstructive treatment of aortic stenosis in infants.Methods. Medical histories and protocols of autopsies of three newborns were studied after surgical treatment of aortic coarctation. The operations were performed in children at 8th, 10th and 15th day after birth. In two cases, resection of the aortic lumen narrowing, botulinum duct ligation and formation of a direct aortic anastomosis were performed. In one observation, a closed balloon dilatation of the aorta in the area of constriction was used. When performing autopsy, the size of the heart, the perimeter of the aorta at the surgical sites and various parts of the aorta were examined. The fragments of the wall of the aortic sections were cut out and fixed in 10% neutral formalin. Histologic sections were prepared in a conventional way followed by staining them with hematoxylin-eosin or picrofuxin by Van Gieson, while elastic fibers were stained with rezorcin-fuchsin by Hotchkiss and Periodic acid–Schiff (PAS) in order to detect mucopolysaccharides.Results. Cellular/intercellular relationships in various parts of the aorta following aortic coarctation in infants have some morphological features. Morphometric examination of the heart and aorta showed a significant increase in the volume and mass of the heart compared with the normal values due to myocardial hypertrophy of the right and left ventricles of the heart. An uneven narrowing of the aortic lumens was most pronounced in the arch and isthmus as compared to the ascending and thoracic parts of aorta. Morphological examination of the aortic wall in the constriction zones demonstrated the presence of coagulation necrosis, lysis of elastic, collagen fibers with surrounding hyperplasia of smooth myocytes, newly formed thin-walled capillary vessels. Outside the coarctation zone, the most significant changes characterized by the development of hypoelastosis, non-uniform accumulation of acid mucopolysaccharides were observed in the walls of the arch and the ascending aorta. Conclusion. In infants with coarctation of the aorta, dilatation of the ascending aorta with compensatory hypertrophy of the heart is observed, and a muscle-fibrous tissue, rich in smooth myocytes and newly formed thin-walled vessels, tends to develop in stenotic zones. The risk of restenosis development is believed to depend on the prevalence and severity of proliferative processes of the cellular elements of the aorta, which allows us to consider early surgical interventions to prevent irreversible destructive changes as justifiable.Received 2 February 2017. Accepted 27 May 2017.Funding: The study required no additional funding and sponsorship.Conflict of interest: The author declares no conflict of interest.AcknowledgementsThe author expresses his gratitude towards Professor S.V. Shlyk, Dr. Sci. (Medicine), Rector of Rostov State Medical University, Professor N.I. Volkova, Dr. Sci. (Medicine), Pro-Rector for Research of Rostov State Medical University and the researchers of the Molecular/Biological &amp; Optical Research Methods Department.

Balloon dilatation of native coarctation of aorta in infants - short term clinical result

Background: Balloon dilatation with or without placement of stent in native coarctation offers a good alternative to surgery. Aim: To determine feasibility and safety of primary balloon angioplasty in infants with coarctation of aorta. Materials and Methods: This was a retrospective, observational study of 44 consecutive infants undergoing balloon dilatation of native coarctation of aorta during a 4 year period from July 2009 to July 2013. Demographic details, previous history and data of chest X-ray, electrocardiogram and sequential echocardiography were collected for all the patients. The patients were followed up at 1 months, 6 months and 1 year thereafter. Results: The reintervention rate was 20.45% after successful procedure. Two patients having hypoplastic arch had successful procedure with 1 requiring reintervention. Left ventricular dysfunction was observed in 15 patients, out of them 11 patients improved immediately after the procedure. Thirty five (79.55%) patients did not undergo reintervention in whom mean gradient was reduced from 48.05±15.26 mm Hg to 10.97±5.8 mm Hg after percutaneous reintervention (p&lt;0.0001). Also, mean diameter in this group was improved (1.94±0.52 vs 6.07±1.84 mm; p &lt;0.0001). Early age of presentation was identified as a contributor of reintervention in the study population (p=0.009). Conclusions: This study results show that BDC in infants is a safe and feasible technique that could be effectively used as an option of surgery in order to reduce mortality and morbidity.

A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience.

Transcatheter treatment of aortic coarctation (CoA) via stent implantation has become an established treatment option depending on the patient's age and CoA type. The Osypka BabyStent(®) is a low-profiled, balloon-expandable cobalt-chrome stent to treat aortic CoA in infants, which is breakable to permit unrestricted growth. We hereby evaluated our initial clinical experience to demonstrate the feasibility and efficacy of this new nonlicensed device, which we have occasionally implanted in critically ill patients or when redo-surgery would entail an excessively high risk. Retrospective single-center analysis of all available data during and after treatment with a BabyStent implanted in infants with considerable re-CoA or reobstruction of the aortic arch after former surgery. All interventions took place under fluoroscopy and conscious sedation with local anesthesia or general anesthesia. Five BabyStents were implanted in four infants with technical success in all of them-median age 10 weeks (range 5-21), median bodyweight 3.8 kg (range 2.7-4.5). Aortic diameters enlarged from median 2.25 mm (range 1.5-3.3) to median 5.3 mm (range 4.6-6.0). The follow-up period lasting up to 26 months (median 8.5, range 2-26) was uneventful concerning stent-related complications. BabyStent(®) implantation for recoarctation was effective. However, our initial experience with the device is limited to short- and midterm follow-up only. None of the stents was subsequently overdilated with the intention to break due to our patients' limited somatic growth so far. A multicenter survey has been initiated to justify device approval.

Reparación quirúrgica de coartación aórtica en lactantes menores

The study's purpose is to present our experience with surgical correction of aortic coarctation in infants, at short and medium term, particularly morbidity and mortality. This is a retrospective observational and descriptive trial. We included all infant patients undergoing surgical correction of AC. All data were obtained from the clinical database of the hospital. We included 20 patients with AC. The surgical technique was extended coarctectomy in 19 patients and, in one patient, a subclavian artery flap was performed. In all patients, the average time of aortic clamping was 18min. The residual gradient measured by echocardiography was in average of 12.2mmHg. One patient died of sepsis secondary to pneumonia. The main cause of immediate postoperative morbidity was systemic hypertension in seven patients, nosocomial infection in four patients with development of sepsis, one patient had to be reoperated due to high gradient. One patient had cholestatic syndrome. Eighteen patients required a transfusion at some time during their hospital stay. Average in-hospital stay was of 12 days. The aortic coarctation surgery has had favorable results so far and we can conclude that the program has been successful. The surgical technique has shown low mortality and complications and midterm follow-up shows low rate of recoarctation.

Early and mid‐term results with the growth stent—A possible concept for transcatheter treatment of aortic coarctation from infancy to adulthood by stent implantation?

Evaluation of the Growth Stent-a stent consisting of two stent halves connected by reabsorbable sutures-for the treatment of aortic coarctation in infants. Surveillance study of 13 Growth Stents implanted in 12 patients aged 1-15 months (median 5 months). Body weight ranged from 3.4-12.8 kg (median 5.4 kg). Eight patients suffered from aortic (re-)coarctation, four of them from stenosis of the aortic anastomosis after a Norwood I procedure. The follow-up period was 24 months (11-51 months). Pressure gradients immediately after stent implantation decreased from 30 mm Hg (range 20-50 mm Hg) to 8 mm Hg (range 0-15 mm Hg). Five patients had one (3 pts) or two (2 pts) balloon dilations 3-28 months (median 12 months) after Growth Stent implantation. The median pressure gradient decreased from 25 mm Hg (range 15-30 mm Hg) to 15 mm Hg (range 5-25 mm Hg). Six patients received a large stent after 19-34 months. Median body weight was 11.8 kg (9.4-15 kg). The Growth Stent is suitable for the acute treatment of aortic coarctation in infants and can be overstented later on--if necessary--with a larger stent without causing restriction.

Extended Resection and End-to-End Anastomosis for Aortic Coarctation in Infants: Results of a Tailored Surgical Approach

The surgical repair of aortic coarctation in infants has evolved over time. This study evaluates our current approach utilizing extended end-to-end anastomosis without prosthetic material to enlarge all areas of aortic arch hypoplasia. The Michigan Congenital Heart Center database was reviewed for infants who underwent repair of isolated aortic coarctation from January 1, 1990, to January 1, 2000. Eighty-three infants underwent surgical repair of isolated coarctation during this decade. Median age at repair was 21 days (range, 2 to 365). Repair was performed through thoracotomy in 72 patients. Because of severe transverse arch hypoplasia, the remaining 11 infants underwent median sternotomy with circulatory arrest. There were 2 deaths: 1 due to pulmonary hypertension in a patient with alveolar capillary dysplasia and 1 late death due to pneumonia in a patient with noncardiac anomalies. Neither patient had residual coarctation. Technique-related complications of bronchial compression, chylothorax, and vocal cord paralysis were noted in 4 patients. Follow-up data were available for 66 patients (80%) with mean follow-up duration of 4.5 years (SD +/- 3.1). Reintervention was required in 4 patients (6%). One underwent reoperation after 1 month, and 3 underwent balloon angioplasty within 7 months of initial repair. The remaining 61 patients are asymptomatic, on no antihypertensive medications, and have aortic arch gradients less than 15 mm Hg. One developed subaortic stenosis necessitating resection. Tailored surgical repair for aortic coarctation has a low rate (6%) of residual and recurrent coarctation even when performed in infants. Mortality and morbidity are low.

Cerebral oxygen balance is impaired during repair of aortic coarctation in infants and children

During repair of aortic coarctation through a left thoracotomy without cardiopulmonary bypass, clamping the proximal transverse aortic arch occludes antegrade flow to the left carotid and vertebral arteries. It is assumed that flow through the right carotid and vertebral arteries is adequate for cerebral perfusion. The study objective is to determine whether aortic occlusion impairs left hemispheric cerebral oxygen balance measured by near-infrared spectroscopy. In 18 children having repair of aortic coarctation, we measured the maximum change and integral for hemoglobin D (difference of oxyhemoglobin and deoxyhemoglobin), total oxygenation index, and the redox state of cytochrome aa3. Thirteen subjects had recordings from the left hemisphere to test the hypothesis that aortic occlusion impairs left hemispheric oxygen balance. Five subjects had recordings from the right hemisphere for comparison. After aortic clamping, a significant decrease in hemoglobin D was observed in recordings from the left hemisphere compared with those from the right hemisphere (P = .03, maximum change in hemoglobin D). Total oxygenation index and cytochrome aa3 were generally preserved. There was an inverse linear relationship for the change in hemoglobin D during clamp application and after removal (Spearman rho = -0.74), with increased hemoglobin D after clamp removal in those subjects with the greatest decrease of hemoglobin D during arch occlusion. Linear regression analysis identified nitroprusside administration as significantly associated with a decrease in hemoglobin D (P < .001). Significant impairment in left hemispheric cerebral oxygen balance was identified during arch clamping. The neurodevelopmental significance of impaired cerebral oxygen balance detected by near-infrared spectroscopy during aortic coarctation repair remains to be elucidated.

Repair of aortic coarctation in infants: Results of a tailored surgical approach in the modern era

Repair of aortic coarctation in infants: Results of a tailored surgical approach in the modern era

Palliative stent implantation for aortic coarctation in premature infants weighing

Severe aortic coarctation in premature infants with very low birth weight poses specific therapeutic challenges because surgery is associated with increased risk and a higher restenosis rate. 1 Bacha E.A. Almodovar M. Wessel D.L. Zurakowski D. Mayer J.E. Jonas R.A. del Nido P.J. Surgery for coarctation of the aorta in infants weighing less than 2 kg. Ann Thorac Surg. 2001; 71: 1260-1264 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar Medical palliation with prolonged prostaglandin (PGE) infusion is associated with high output failure, pulmonary overcirculation, and marginal systemic perfusion, resulting in poor weight gain, infections, and excessive delay of surgical repair. 2 Reddy V.M. McElhinney D.B. Sagrado T. Parry A.J. Teitel D.F. Hanley F.L. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg. 1999; 117: 324-331 Abstract Full Text Full Text PDF PubMed Scopus (151) Google Scholar Palliative balloon angioplasty is associated with a very high early restenosis rate, 3 Kothari S.S. Juneja R. Saxena A. Reddy S.C. Sharma S. Balloon dilatation of simple aortic coarctation in neonates and infants. Indian Heart J. 1998; 50: 187-192 PubMed Google Scholar , 4 Rao P.S. Galal O. Smith P.A. Wilson A.D. Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol. 1996; 27: 462-470 Abstract Full Text PDF PubMed Scopus (211) Google Scholar and limited vascular access prohibits the necessary repeat dilations. We describe a novel approach using intravascular stents to palliate severe aortic coarctation in 3 premature infants weighing <1,300 g.

Secondary hypertension in children.

Secondary hypertension is a potentially curable disease. One-hundred-and thirty six children was diagnosed as hypertension in the National Taiwan University Hospital from January 1992 to June 1998 and they were retrospectively reviewed and analysed for the etiological factors, presentation, and clinical outcome. The most common cause of hypertension was coarctation of aorta in infants and systemic lupus nephritis in adolescents. These children often presented symptoms and signs not directly related hypertension (37.5%). Twenty eight children (20.6%) died. The hypertension of the survival had been controlled by surgery, chronic hemodialysis, or medication.

Balloon angioplasty of native aortic coarctation in infants 3 months of age and younger

The use of balloon dilation to treat native aortic coarctation is controversial, particularly in infants. Between January 1991 and September 1996, 12 patients < or = 3 months of age with native coarctation of the aorta (CoA) underwent balloon angioplasty (BA). All 12 lesions were dilated successfully with a mean reduction in peak systolic gradient from 49.3 +/- 16.5 mm Hg to 6.8 +/- 4.0 mm Hg (p < 0.001) and a mean increase in minimum CoA diameter from 2.4 +/- 0.6 mm to 5.5 +/- 1.3 mm (p < 0.001). Intimal flaps or tears were detected immediately after BA in 4 (33%) of 12 patients by angiography and in 8 (89%) of 9 patients by intravascular ultrasonography. No deaths or major complications related to the BA occurred. One patient had documented asymptomatic femoral artery obstruction, and one patient with hydrops fetalis and congenital pleural effusions died with gram-negative sepsis 1 week after the procedure. Follow-up was available for 10 patients (1 was lost to follow-up) between 2 months and 4.1 years (mean 2.4 +/- 1.3 years) after BA. No patient had an aortic aneurysm. Restenosis occurred in 5 (50%) of 10 patients, requiring reintervention a mean of 2.6 +/- 2.1 months after BA. One patient underwent surgical repair. Repeat BAs were performed in the other four patients; three were successful, and one with partial gradient relief required surgical repair. Five patients have not required reintervention a mean of 2.9 +/- 1.0 years after the initial BA. Among these five patients, follow-up intravascular ultrasound performed in three patients a mean of 2.0 +/- 1.9 years after BA showed favorable endovascular remodeling. There was a tendency for early reintervention in patients < 1 month of age and coexistence of a patent ductus arteriosus at the time of BA. In conclusion, selected infants < or = 3 months of age with discrete native CoA may be treated initially with balloon dilation. Most patients who have restenosis respond successfully to repeat BA.

Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children

Objectives. To evaluate the usefulness of balloon angioplasty for relief of native aortic coarctation, we reviewed our experience with this procedure, with special emphasis on follow-up results.Background. Controversy exists with regard to the role of balloon angioplasty in the treatment of native aortic coarctation.Methods. During an 8.7-year period ending September 1993, 67 neonates, infants and children underwent balloon angioplasty for native aortic coarctation. A retrospective review of this experience with emphasis on long-term follow-up forms the basis of this study.Results. Balloon angioplasty produced a reduction in the peak-to-peak coarctation gradient from 46 ± 17 (mean ± SD) to 11 ± 9 mm Hg (p < 0.001). No patient required immediate surgical intervention. At intermediate-term follow-up (14 ± 11 months), catheterization (58 patients) and blood pressure (2 patients) data revealed a residual gradient of 16 ± 15 mm Hg (p > 0.1). When individual results were scrutinized, 15 (25%) of 60 had recoarctation, defined as peak gradient >20 mm Hg. Recoarctation was higher (p < 0.01) in neonates (5 [83%] of 6) and infants (7 [39%] of 18) than in children (3 [8%] of 36), respectively. Two infants in our early experience had surgical resection with excellent results. Three patients had no discrete narrowing but had normal arm blood pressure and had no intervention. The remaining 10 patients had repeat balloon angioplasty with reduction in peak gradient from 52 ± 13 to 9 ± 8 mm Hg (p < 0.001). Reexamination 31 ± 18 months after repeat angioplasty revealed a residual gradient of 3 to 19 mm Hg (mean 11 ± 6). Three (5%) of 58 patients who underwent follow-up angiography developed an aneurysm. Detailed evaluation of the femoral artery performed in 51 (88%) of 58 patients at follow-up catheterization revealed patency of the femoral artery in 44 (86%) of 51 patients. Femoral artery occlusion, complete in three (6%) and partial in four (8%), was observed, but all had excellent collateral flow. Blood pressure, echocardiography-Doppler ultrasound and repeat angiographic or magnetic resonance imaging data 5 to 9 years after angioplasty revealed no new aneurysms and minimal (2%) late recoarctation.Conclusions. On the basis of these data, it is concluded that balloon angioplasty is safe and effective in the treatment of native aortic coarctation; significant incidence of recoarctation is seen in neonates and infants; repeat balloon angioplasty for recoarctation is feasible and effective; and the time has come to consider balloon angioplasty as a therapeutic procedure of choice for the treatment of native aortic coarctation.

Surgical versus balloon therapy for aortic coarctation in infants ≤ 3 months old

Objectives. This study compared the efficacy and safety of balloon angioplasty with surgical correction of native aortic coarctation in infants ≤3 months old.Background. There is a controversy with regard to the role of balloon angioplasty in the treatment of aortic coarctation, especially in young infants.Methods. Data from 29 infants ≤3 months old undergoing therapy for aortic coarctation during the decade ending 1992 were analyzed. Fourteen infants underwent surgery, and 15 had balloon angioplasty. The sole criterion for allotment to the balloon group was the availability of an interventional cardiologist at the time of presentation of the infant.Results. The surgical and balloon groups were comparable (p > 0.1) with regard to age (27 ± 35 [mean ± SD] vs. 29 ± 27 days), weight (3.5 ± 0.9 vs. 3.8 ± 1.0 kg) and prevalence (7 of 14 vs. 8 of 15) and type of associated defects. Operative (1 of 14 vs. 1 of 15) and late (3 of 13 vs. 3 of 14) mortality, immediate gradient relief (36 ± 25 to 10 ± 9 mm Hg vs. 41 ± 14 to 6 ± 6 mm Hg) and follow-up gradient (27 ± 27 vs. 24 ± 19 mm Hg) were similar (p > 0.1). Infants with a gradient > 20 mm Hg at follow-up (6 of 13 vs. 7 of 14) and need for reintervention (6 of 13 vs. 7 of 14) were also similar (p > 0.1) in both groups. Duration of hospital stay during the first intervention was higher (p < 0.05) in the surgical (32 ± 37 days) than the balloon (7 ± 6 days) group. Similarly, duration of endotracheal intubation and mechanical ventilation was longer (p < 0.05) in the surgical (12 ± 16 days) than the balloon (2 ± 3 days) group. Complications after surgical intervention (0.86 events/patient) were higher (p < 0.01) than those seen after balloon angioplasty (0.27 events/patient). However, the lack of significant differences observed for mortality rates and residual gradients may be due to low statistical power to detect differences (16% to 49%), implying that this may be due to either actual lack of statistical difference or small sample size.Conclusions. The data indicate that the degree of relief from aortic coarctation and the frequency with which reintervention is needed are similar in both groups. However, the morbidity and complication rates are lower with balloon than with surgical therapy. These data suggest that balloon angioplasty may be an acceptable alternative to surgical correction in the treatment of symptomatic aortic coarctation in infants ≤3 months old.

Aortic obstructions in infants and children: Balloon dilatation for aortic coarctation

This review describes the history, technique, and results of balloon angioplasty in the treatment of native and recurrent aortic coarctation in infants and children. The results of angioplasty are compared to those obtained with several surgical techniques. In 24 children treated for recoarctation, the mean peak systolic pressure difference across the obstruction was reduced from 40.3 ± 17.4 mm Hg before angioplasty to 8.5 ± 8.3 mm Hg immediately afterward and 7.5 ± 7.5 mm Hg at an average 54-month follow-up review. In children and older infants, the procedure is successful as demonstrated in several series by acceptable relief of obstruction (residual pressure difference <20 mm Hg) in 70% to 100%, with subsequent restenosis in 20%. In neonates with native aortic coarctation, angioplasty is often unsuccessful and associated with high rates of restenosis. Complications of the procedure include aortic aneurysm, dissection and rupture, cerebrovoscular accident, femoral arterial injury, paradoxical hypertension, and death. The early results of balloon angioplasty for aortic coarctation indicate that the procedure is as safe and effective as surgery for the treatment of recoarctation in children. In children and older infants with native coarctation, the procedure is a less invasive and less costly alternative to surgery. In neonates, angioplasty is much less effective and should be considered as a palliative alternative to surgery.

13 Balloon angioplasty of native aortic coarctation in infants and children – Medium-term results

13 Balloon angioplasty of native aortic coarctation in infants and children – Medium-term results

Long-term follow-up of aortic coarctation in infants, children and adults

AbstractWe have studied 140 patients undergoing corrective surgery for aortic coarctation between 1952 and 1972, following them for a mean period of 23 years. Of the patients, 19 underwent surgery in infancy (age range 15 days to 190 days, mean 84 days), 52 during childhood, with a mean age of 11.8 years (range 1 years), and 69 as adults (age range 18−50 years, mean 30.5 years). All infants were symptomatic at presentation and fared poorly because of associated cardiac lesions. Their operative mortality was 11%, and mortality prior to discharge from hospital was 21%. Of the survivors, 38% required surgery for recurrent coarctation. There were three late deaths. Of the survivors, 90% were asymptomatic at long-term follow-up. Only six children (11%) were symptomatic at presentation. There was no operative or early postoperative mortality, and only three late deaths (6%). Of the 49 survivors, 96% were asymptomatic, and only six required antihypertensive medication. The recoarctation rate was 9% (four patients). In the group undergoing surgery as adults, 42% were symptomatic at presentation with 90% being hypertensive. There were two postoperative deaths and a late mortality of 22%, which was mainly related to the cardiovascular complications. None of the adults had suffered recoarctation, but 48% remained hypertensive. Our study confirms that the prognosis of patients with aortic coarctation presenting in infancy is related to presence of associated cardiac anomalies and operative complications. The prognosis in older patients, and particularly adults, is related to residual hypertension and resultant cardiovascular disease. Surgical correction reduces symptoms and improves life expectancy, regardless of the age at operation, with the best overall prognosis being obtained for those undergoing surgery as children.