Balloon Angioplasty Of Coarctation Research Articles

Coarctation Balloon Angioplasty in a Rare Case with Congenitally Corrected Transposition of the Great Arteries and Ebstein’s Anomaly

The coexistence of aortic coarctation, Ebstein’s anomaly, and transposition of the great arteries is an extremely rare occurrence. In this case report, we present a unique instance of complex congenital heart disease in a neonate who exhibited respiratory distress and cyanosis at birth. Echocardiography revealed several significant findings: congenitally corrected transposition of the great arteries, Ebstein’s tricuspid anomaly, moderate-to-severe tricuspid regurgitation, a small muscular ventricular septal defect, and an abnormal left arch with severe coarctation of the aorta. Due to the patient’s unstable hemodynamic status, balloon angioplasty was performed. Subsequent long-term clinical follow-up confirmed the efficacy of this intervention.

A rare complication after an interventional procedure using the common carotid: carotid pseudoaneurysm in an infant.

The carotid artery is a valuable vascular access that can be used in patients who have undergone repetitive interventional and surgical procedures and premature babies. In the past, cut-down was used but nowadays, mostly the procedure is performed under ultrasonographic guidance. Complications such as bleeding, haematoma, and pseudoaneurysm may occur when the carotid artery is used as a vascular access for the procedures such as aortic balloon valvuloplasty, coarctation balloon angioplasty, or after interventional or surgical treatments to the carotid artery. Although pseudoaneurysm is very rare, prompt diagnosis and accurate treatment planning are life-saving. In this article, the diagnosis and treatment of pseudoaneurysm in the left common carotid after transcatheter coarctation balloon angioplasty in a 6-month-old infant will be presented.

Subcutaneous Nodules in a 28-week-old Girl.

Subcutaneous Nodules in a 28-week-old Girl.

Carotid Artery Cut-Down in Pediatric Cardiac Catheterization: When and How?

<b>Background:</b> Vascular access used for pediatric cardiac catheterization is one of the most important factors that affects the success of the procedure. We aimed to compare the effect, success, and complications of cardiac catheterizations performed by carotid cut-down or femoral puncture in newborns or young infants. <b>Methods:</b> We included who underwent catheterization in our department between 28 January 2017 and 15 April 2021. These patients underwent balloon aortic valvuloplasty, balloon coarctation angioplasty, ductal stenting, diagnostic procedures for aortic arch pathologies, and modified Blalock-Taussig in-shunt intervention. Patients were divided into two groups: femoral puncture (group = 1) and carotid cut-down (CC, group = 2). <b>Results: </b>Seventy-two catheterization procedures were performed in 64 patients; 32 (44.4%) were performed via the femoral approach and 40 (55.6%) were performed via the carotid approach. Sixteen (22.2%) procedures were diagnostic and 56 (77.8%) procedures were interventional. CC was performed in 13 (32.5%) patients with failed femoral intervention. Patients in the CC group had shorter durations of procedure, vascular access, and anesthesia, compared with the femoral access group (80.9 and 116.2 min, <i>p</i> = 0.001; 12.9 and 22.5 min, <i>p</i> = 0.001; 140.9 and 166.6 min, <i>p</i> = 0.001, respectively). Patients who underwent CC had fewer complications than did patients in the femoral access group (2.5% and 21.8%, respectively; <i>p</i> = 0.01); larger sheats were used in CC patients (<i>p</i> = 0.028). <b>Conclusion: </b>The carotid artery can be successfully used as a primary catheterization route, particularly in patients with small body weight and patients who require rapid vascular access, or stenting of the vertical duct.

Immediate Outcomes of Balloon Angioplasty for Coarctation of the Aorta in infants and children

Background: Coarctation of the aorta (CoA) is one amongst commonest congenital heart diseases (CHD) which reuires early intervention to avoid morbidity and mortality. Balloon angioplasty (BA) can be offered in place of surgery in selected cases. Aim: To evaluate the safety of procedure and efficacy of catheter intervention balloon angioplasty for CoA as an alternative to surgery and to identify the factors related with poor outcome of the intervention in infants and children Methods: The study was a retrospective observational cohort study of 46 infants and children undergoing BAS during a six-year period (Jan 2014 to May 2020). Demographic detail history and investigation including echo and ECG were collected for all the patients. Immediate pre and post procedure complications were noted. Results: Forty six (46) children and infant patients , underwent balloon angioplasty 29 were male and 17 were female. Patients were divided into two groups. Group A included patient with successful outcome and group B included those with suboptimal results. Characteristics of both groups we studied. In group A the median age was 6.3 years and median weight was 15 kg whereas in group B median age was 3.5 years and median weight was 9 kg. Forty patients had native CoA (86.9%) while six patients were post op (13%). There was no mortality. One patient had a small aneurysmal formation (3%). Four patients had a transitive loss of pulse. Thirty-four patients had a successful outcome (73.9%) while twelve patients had a suboptimal result (26%). Conclusion: Coarctation angioplasty has good early outcome and it can be considered as a sustainable alternative to surgery in critical infants and children patients high risk of mortality with surgery. wise selection of patients, use of improved low-profile catheters and better patient care can reduce the complications and incidence of mortality. Keywords: Coarctation, Balloon angioplasty

Percutaneous Common Carotid Artery Access for Cardiac Interventions in Infants Does Not Acutely Change Cerebral Perfusion.

Pediatric cardiac interventions via percutaneous common carotid artery (CCA) access have been shown to be safe and effective. However, the impact of placement of a sheath in the carotid artery for interventions on cerebral perfusion is unknown. In this study we used cerebral near-infrared spectroscopy (NIRS) to analyze the effects of percutaneous CCA access for cardiac interventions on cerebral perfusion. This study is a retrospective chart review carried out at a tertiary care center on all pediatric patients who underwent percutaneous cardiac catheterization via carotid artery access from January 2010 to January 2020. All patients who had ipsilateral NIRS recorded on the side of carotid artery access were included. Patients with only partial or no ipsilateral NIRS data were excluded. The primary outcome measure was the change in NIRS upon CCA access; the mean NIRS for 15min before obtaining access was compared to the mean NIRS during the procedure and to the mean NIRS 15min after removal of the CCA sheath. We hypothesized that there would be a significant drop in NIRS values on the side of CCA access. There were 48 catheterizations in the study period where percutaneous CCA was accessed. Of those, 21 catheterizations had complete data and were included in the study. 13 (62%) were of males. The median age was 23days (IQR 7-79). The indications for CCA access were patent ductus arteriosus stent implantation (n = 13; 62%), aortic valvuloplasty (n = 5; 24%), balloon angioplasty of coarctation of aorta (n = 2; 10%), and renal artery angioplasty (n = 1; 4%). In 16 patients (72%), the left common carotid artery was accessed. The median weight of the patients was 3.3kg (IQR 2.8-2.9). The most common sheath size used was 4F, in 16 patients (72%). The mean NIRS prior to the procedure was 67 ± 15%, during the procedure was 68 ± 20%, and after removal of sheath was 68 ± 21%. Paired t test of cerebral NIRS before, during, and after the procedure showed no significant change with CCA access (P = 0.08). No patient in the series had a documented neurologic deficit following the procedure. Percutaneous CCA access was not associated with a decrease in NIRS on the side of the access during the procedure, suggesting there was no significant acute change in cerebral perfusion with CCA access.

Balloon coarctation angioplasty with non-compliant balloon in low-birth-weight premature infants.

Although surgery is the standard treatment for native coarctation in neonates, it carries a high risk of complications. Percutaneous balloon angioplasty may be considered as an alternative treatment. The materials used in the intervention should be selected carefully to reduce complications. We recommended the use of non-compliant balloons in risky babies. They are more effective in the treatment of strick stenosis than compliant balloons.

The results of interventional catheterization in infants weighing under 2,000 g.

The aim of this study was to evaluate the early and mid-term results of interventional cardiac catheterization and procedure-related complications in infants weighing <2,000 g. Between May 1998 and April 2017, 22 patients (14 males, 8 females; mean age 14±8.4 days; range, 1 to 30 days) weighing <2,000 g who underwent a total of 23 interventional cardiac catheterization were retrospectively analyzed. Procedures were balloon coarctation angioplasty in 14, balloon atrial septostomy in five, balloon aortic valvuloplasty in one, balloon pulmonary valvuloplasty in one, patent ductus arteriosus closure in one, and stent placement in the ductus in one patient. Another patient underwent balloon coarctation angioplasty and balloon aortic valvuloplasty in the same session. The overall success rate of the interventional procedures was 95.6%. The mean follow-up was 3.2±1.6 years (range, 1 to 5.5) for 18 patients with available records. The rate of serious complications was 18%. The most frequent complications in the early period were low hemoglobin levels requiring erythrocyte suspension transfusion (54.5%) and vascular injury (54.5%). Two patients required reintervention, one patient required surgery after the second intervention, and three patients required only surgery. Six patients underwent palliative interventional procedures, and interventional procedures led to definitive treatment in five patients. The mortality and morbidity rate of surgery is high in premature under 2,000 g infants and interventional heart catheterization can be life-saving in this patient group, although it is associated with significant complications in low birth weight newborns.

Immediate and Short-term Follow-Up of Aortic Coarctation Balloon Angioplasty and Stenting

Background Aortic Coarcatation (CoA) is one of the congenital heart diseases with the rate of 5-8% of Coronary heart diseases(CHDs). Balloon angioplasty is now one of the effective way of treatment for CoA, native or Re-coarctation (Re-CoA). We aimed to assess the immediate, and short term response to angioplasty and stenting, and also complications. Materials and Methods Balloon angioplasty with our without stenting was performed for 53 patients with native or Re-coarcatation angioplasty (39 balloon angioplasty alone, and 14 balloon and stenting). Pressure gradient across the CoA segment was measured initially by Echo and pre, and Post procedure. Echocardiography was also used for follow up assessment during 24 hours, one and 6 months afterward. Results Among 53 patients, 52.8% were male. There were 98.2% native and 3.8% Re-CoA. The mean age of patients was 8.65 ± 8.37 years, and the mean weight was 25.82±20.73 kg. The mean pressure gradient acrossthe CoA site before angioplasty was 24.88±12.32, and post procedure gradient was 4.77±6.42 (p<0.001). One of the patients experienced aneurysm formation at CoA segment site post balloon angioplasty. Conclusion On the basis of these data balloon angioplasty is safe, and effective in the treatment of native or Re-CoA. These results suggest that CoA angioplasty could be an effective alternative to a surgical approach, and gives good immediate results, although follow up studies are necessary to evaluate complications, and the long term effect on blood pressure in comparison to surgical approach.

Transcatheter Therapy for Coarctation of Aorta: Analysis of 150 Cases

Background: This study was conducted to analyze the outcome of transcatheter intervention of Coarctation of aorta carried out on 150 patients.Methods: This was a retrospective study, conducted in Pediatric Cardiology Unit, Combined Military Hospital Dhaka and Lab Aid Cardiac hospital from January 2007 to December 2015. Data were collected by chart review.Results: Age of the patient varies from 7 days to 28 years. Sixty six (44%) patients were female and rest were male. Native coarctation was 138 (92%) and post surgical re-coarctation was 12 (8%). Neonatal critical Coarctation was 60 (40%). Thirty six (24%) cases were detected when they were investigated for hypertension. Abdominal coarctation was found in 18 cases (12%). Multiple coarctation was found in 9 (6%) cases. Six cases (4%) had balloon angioplasty twice and 12(8%) cases had stenting after recoarctation as they had body weight above 15 kg. Aneurysm and aortic dissection was observed in one (0.66%) case. Thrombophlebitis observed in 3(2%) cases and temporary pulse loss in 9 (6%) cases. No mortality was noticed.Conclusion: Balloon angioplasty for coarctation of aorta and stenting in suitable cases is a safe and effective measure to treat coarctation of aorta.Cardiovasc. j. 2017; 10(1): 56-62

Stenting of Coarctation of Aorta in a Post Device Closure of Patent Ductus Arteriosus and Balloon Coarctoplasty patient: A Case Report

Intravascular stent treatment of coarctation of Aorta has proved successful in 96-98% cases. The decision as to which method should be utilized for treatment of coarctation, out of the option of surgical, balloon angioplasty and stent implantation is still controversial in our center. We do balloon angioplasty for majority of cases as stents are expensive and patients are very young. Here we are reporting a case who had device closure of patent ductus arteriosus (PDA) 3 month ago along with balloon angioplasty of coarctation. But patient developed re coarctation within one month and then intravascular stent was implanted.Cardiovasc. j. 2016; 9(1): 64-67

Antegrade transvenous balloon angioplasty for coarctation of the aorta in infants with ventricular septal defect

For a newborn, surgical correction has been the primary treatment of native coarctation at most centers; however, there has been an increased use of balloon angioplasty (BA). The anterograde transvenous (AT) technique is another alternative way for coarctation (AoC) angioplasty in low weight patients with large ventricular septal defect (VSD).Four, 5-day-old to 7-month-old, infants weighing 2500, 2700, 2800, and 3400g, respectively presented to emergency unit (EU) with cyanosis, tachypnea, and loss of weight. Echocardiography demonstrated AoC and VSD. All four children were admitted to the EU with hemodynamic compromise and critically ill status. We used femoral vein for sheath and used VSD to enter left ventricle from right antegrade route, and performed BA without any complication.AT described in this report is another alternative way for coarctation angioplasty in patients with large VSD. We suggest that AT BA can be applied to small infants in situations where surgery might have been hazardous.

Percutaneous carotid artery access in infants < 3 months of age.

Carotid artery access in infants with congenital heart disease undergoing cardiac catheterization via a surgical cut down has been well described. There is a paucity of information regarding percutaneous carotid artery (CA) access in infants <3 months. A retrospective review of infants <3 months of age undergoing cardiac catheterization via percutaneous CA approach was performed after IRB approval. Between January 2012 and May 2015, 18 patients underwent 20 procedures; median age 13 days (2-77); median weight 3.3 kg (1.6-5). Procedures performed were patent ductus arteriosus (PDA) stenting (8), modified blalock taussig (BT) shunt stenting (3), balloon aortic valvuloplasty (6), and balloon angioplasty of coarctation (3). Percutaneous access was obtained with a Doppler needle under ultrasound guidance into the right (16) and left CA (4). Sheath size used was 4 Fr (17), 5 Fr (2), and 6 Fr (1). Median time to sheath insertion was 6.5 min (2-20). Percutaneous access was obtained successfully in all cases. There were no major procedural complications. There were two minor complications; hypotension, and ductal spasm. Hemostasis was achieved by manual compression; median time was 14.5 min (8-36). There were two post-procedural complications involving development of CA pseudo aneurysms that were repaired surgically. Post-procedure CA patency was documented by angiography (3), MRA (3), or vascular ultrasound (14). There were no documented arterial occlusions. Our experience suggests that percutaneous CA access in infants <3 months of age is safe and feasible with preserved vascular patency and no neurological adverse events.

12. Percutaneous balloon angioplasty for critical aortic coarctation in newborns and infants: Is it still a valid option?

Background Coarctation of aorta may present as severe heart failure in infants and may lead to myocardial dysfunction. Current evidence supports surgical management of neonatal coarctation. However, it can be precarious in critically sick infants. Aim and objective To investigate the safety, efficacy, immediate and mid-term outcome of percutaneous balloon angioplasty (BAP) for infantile aortic coarctation in critically sick patients. Methods and patients Data of all patients under age of 6 months who underwent balloon angioplasty for coarctation were reviewed. Results Between January 2008 and April 2014, 15 infants were identified with coarctation with a mean weight of 3.4 kg (1.4–5 kg) and median age of 54 days (4–142 days). All patients were critically sick, needed admission in intensive care unit for inotropic or ventilatory support. All underwent successful percutaneous balloon angioplasty with no major complications. The clinical condition and left ventricular function improved leading to discontinuation of prostaglandin and weaning from inotrope and ventilator support. Seven patients underwent elective surgical repair after a mean time of one month, three needed re-dilation and five continued without any further intervention. Conclusions Surgical repair for native neonatal and infantile coarctation is a preferred choice of treatment but it can be challenging in critically sick patients. However, balloon dilation remains a safe and effective temporary palliation for the critically sick patients. Despite of high incidence of restenosis, some patients do not need for mid-term further intervention.

Recent Advancement in Non-surgical Interventional Treatment in Congenital Heart Disease at National Institute of Cardiovascular Disease (NICVD)-a Tertiary Care Hospital of Bangladesh

Background: Treatment of Congenital Heart Disease (CHD) is either Surgical or Interventional. Medical management is mainly symptomatic / palliative. Although surgery is the main mode of treatment but in the recent past non-surgical Interventional method is replacing it because of its multiple advantages over surgical procedures. Since 2005, we started our journey in National Institute of Cardiovascular Diseases with a PDA device closure. In this article we tried to review the success rate of the interventional procedures in this hospital. Methods: The aim of this retrospective study is to review the short term &amp; Intermediate outcome of the non surgical interventional treatment of congenital heart diseases. We included all the interventional rocedures done in this Institute since 2005 upto December 2013. Results: During this period, we performed total 150 cases of patent ductus arteriosus (PDA) device, 20 cases of PDA Coil closure, 60 cases of atrial septal defect (ASD) device, 90 cases of Balloon Pulmonary Valvuloplasty (BPV), 20 cases of Balloon Aortic Valvuloplasty (BAV), 22 cases of Coarctation Balloon Angioplasty, 35 cases of Mitral Valvuloplasty (PTMC), 15 cases of Balloon Atrial Septostomy. Almost all of our intervention procedures were successful except one case of mortality related to procedure of PDA device closure, 4 device embolization (2 ASD &amp; 2 PDA) and one case of PDA coil with persistent Intravascular hemolysis. All the embolized devices were subsequently retrieved surgically with repair. All other patients of interventional treatment are enjoying new life without any morbidity. Conclusion: Thus, we concluded that interventional methods of suitably selected case of congenital heart disease may be an alternative lucrative safe &amp; effective option of remedy for many of the congenital heart diseases. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18354 Cardiovasc. j. 2014; 6(2): 133-142

Balloon Angioplasty of Subatretic Coarctation of the Aorta Using Progressive Larger Balloons

We report a case of subatretic coarctation of the aorta with dilated ascending aorta in a three-year-old boy weighing 14 Kg. Surgical treatment was indicated, but it was refused. Balloon angioplasty of the coarctation was performed using progressive increase in the diameter of the balloons. The diameters of the balloons ranged from 2 to 10 mm, and the gradient decreased from 60 down to 12 mmHg. We conclude that the balloon angioplasty with careful progressive increase in the balloon diameter is safe in the treatment of subatretic coarctation of the aorta with good results.

Huge Aortic Aneurysm After Balloon Angioplasty for Coarctation of the Aorta in an Infant

A 11-month-old boy was referred to our unit for operation. When he was 20 days old, he had balloon dilatation of the aortic coarctation at another institution. He also had a small ventricular septal defect. During the follow-up, asymptomatic aneurysm formation at the previous coarctation site was determined. On physical examination, there was a systolic mummur at the 4th intercostal space. The echocardiographic examination revealed a small perimembraneous-outlet ventricular septal defect and the aneurysm at the coartation site. Cardiac angiography revealed the giant aneurysm of the descending aorta that was 4.4 cm in diameter (Fig. 1; Clip 1). The surgical approach was made though a left posterolateral thoracotomy. At surgery, the aneurysm (Fig. 2) was incised longitudinally (Fig. 3) and both lateral walls and the anterior wall of the aorta that was involved in the aneurysm were resected. The remainder posterior wall was intact and was not integrated in the aneurysm tissue. Patch aortoplasty was performed with a Hemashield patch (Boston Scientific, Natick, MA). The patch was sutured to the aorta in the standard fashion using a running 5/0 prolene suture (Fig. 4). The postoperative course was uneventful. The patient was discharged on the fourth postoperative day. The patient was well at the 25-month follow-up.

Multiple transcatheter interventions in the same session in congenital cardiopathies

Background:To investigate the methods of percutaneous transcatheter interventions for combined congenital heart disease and to evaluate its efficacy in children.Materials and Methods:Thirty cases (ages 3 days-13.5 years, body weight 3-35 kg) that underwent two multiple transcatheter interventions for combined or solitary congenital heart disease were retrospectively analyzed and presented.Results:A total of 61 transcatheter interventions were performed in 30 patients as combined procedures. In 29 patients, two different procedures were combined in the same session, in remaining one patient, combination of three interventions were performed in the same catheter session. Interventions performed in combined procedures were as follows: Coarctation balloon angioplasty in 12 cases, pulmonary balloon valvuloplasty in 10, PDA coil embolization in 10, aortic balloon valvuloplasty in 8, VSD closure in 5, ASD closure in 4, ductal stent implantation in 4, palliative pulmonary balloon valvuloplasty in 3, recanalization and angioplasty of the systemic-pulmonary shunt in 2, balloon atrial septostomy in one, aortic coarctation stent implantation in one, coil embolization of a pulmonary lobar sequestration in one and pulmonary valve perforation plus pulmonary balloon valvuloplasty in one were performed as first or second procedure. There was no mortality or major morbidity in relation to combined procedures.Conclusion:Multiple transcatheter interventions in the same session are feasible, safe and effective with satisfactory good results. Second intervention may be performed as complementary procedure or independently to the first intervention.

Late Cardiovascular Complications After Surgical or Balloon Angioplasty of Coarctation of Aorta in an Asian Cohort

Late cardiovascular complications after intervention for coarctation of the aorta (CoA) might be common. Such data, especially in Asian populations, are still limited. A total of 169 patients with CoA who survived balloon (n = 41) or surgical (n = 128) intervention from 1986 to 2004 were enrolled. The total follow-up was 1,776 patient-years, and the patient age at last follow-up was 14.7 +/- 8.5 years. Reintervention for recoarctation, systemic hypertension, and left ventricular outflow tract obstruction (LVOTO) was subsequently noted in 57 (34%), 36 (21.3%), and 24 (14.2%) patients, respectively, without significant differences between the balloon and surgical groups. The 20-year freedom from reintervention, systemic hypertension, and LVOTO rate was 52%, 78.6%, and 80.8% in the balloon group and 59%, 51%, and 81.9% in the surgical group, respectively. The age at CoA intervention and the aortic geometry after CoA intervention of gothic type were common risk factors for reintervention for recoarctation and late systemic hypertension. In contrast, the presence of bicuspid aortic valves and gothic arch geometry after CoA intervention increased the risk of LVOTO. Plasma renin/aldosterone activities were not elevated in those with or without systemic hypertension. In conclusion, the profile of reintervention for recoarctation and late systemic hypertension after CoA interventions in our Asian cohort with CoA was similar to that observed in white patients. Asian patients might have a lower risk of LVOTO.

Long‐term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue?

Long‐term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue?