Balloon Angioplasty Of Native Coarctation Research Articles

Self- and balloon-expandable stent implantation for severe native coarctation of aorta in adults

Background Balloon angioplasty for native coarctation of the aorta (CoA) in adults, though promising, is sometimes limited by significant residual gradient (>20 mm Hg). Few studies available have reported on use of balloon-expandable stents in such a situation. We evaluated the use of self- and balloon-expandable stents in patients with suboptimal response to balloon angioplasty (BA). Methods Twenty-one hypertensive patients (age, 18 to 61 years; mean, 28.6 ± 11.2 years) with native CoA and in whom results of BA were suboptimal (ie, residual peak systolic gradient [PSG] >20 mm Hg) underwent stent implantation. Balloon-expandable Palmaz stents were implanted in 5 patients (group A) and self-expandable nitinol aortic stents in the remaining 16 patients (group B). Results In group A, PSG decreased from 62.8 ± 10.6 (53 to 80) mm Hg to 28.1 ± 6.3 (22 to 39) mm Hg after BA. Systolic gradient further decreased to 8.3 ± 3.9 (2 to 16) mm Hg ( P < .001) after implantation of the balloon-expandable Palmaz stent. In group B, PSG decreased from 70.2 ± 24.6 (40 to 110) mm Hg to 28.4 ± 9.8 (22 to 42) mm Hg after BA and further reduced to 9.0 ± 5.5 (4 to 16) mm Hg ( P < .001). One of these patients had a nitinol self-expandable stent implanted after a Palmaz stent embolized immediately after deployment. Nitinol stents were easier to deploy and conformed better to aortic anatomy compared with balloon-expandable stents. In group A, the diameter of the coarcted segment increased from 3.8 ± 0.8 mm to 13.3 ± 0.8 mm ( P < .001) after stent implantation and in group B it increased from 4.5 ± 1.1 mm to 14.1 ± 2.1 mm ( P < .001). There was no significant difference between the two groups in the PSG and diameter of the coarcted segment before and after stent implantation. With the exception of one case, in which a Palmaz stent embolized, there was no other complication in our series. On follow-up of 12 to 71 months (mean, 40.7 ± 5.8 months) all the implanted stents remained in their original position and none showed evidence of fracture. Improvement in hypertension was seen in 20 of 21(95.2%) of the patients. On recatheterization and angiography 1.2 ± 0.6 years after implantation in 19 patients, one patient showed an increase in PSG to 27 mm Hg across the nitinol stent and underwent successful redilation. No increase in gradient was seen in other patients. Beneficial late remodeling was seen in 10 of 14(71.4%) of patients restudied after implantation of self-expandable stent. None of the patients showed aneurysm formation. Conclusions Stent implantation is safe and effective in improving suboptimal results after BA for CoA. Self-expandable stents were easier to implant, adapted better to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation as balloon-expandable stents.

Angioplasty for coarctation in different aged patients

Background Differences in the indication and outcome of balloon angioplasty for coarctation in children and adults have not been elucidated sufficiently. The results of balloon angioplasty for coarctation are compared between pediatric and adult age groups. Methods Balloon angioplasty for coarctation of the aorta was performed in 85 patients who were classified according to age and native coarctation/recoarctation. Groups A (patients aged <16 years, n = 32) and B (patients aged ≥16 years, n = 17) included patients with native coarctations. Groups rCoA A (patients aged <16 years, n = 33) and rCoA B (patients aged ≥16 years, n = 3) included patients with recoarctations. Follow-up included 2-dimensional Doppler scanning echocardiography and additional angiography or magnetic resonance imaging. Gradient reductions in groups were compared by use of the independent-samples t test. Kaplan-Meier and log-rank analyses were performed as a means of comparing long-term outcome. Results No mortality occurred. Immediate success was equal in groups A, B, and rCoA A (94%). Dilatation was unsuccessful in 2 patients in group rCoA B. Pressure gradients decreased 23 mm Hg in group A, 31 mm Hg in group B, 18 mm Hg in group rCoA A, and 11 mm Hg in group rCoA B. Pressure gradient drops, compared between groups A and B, showed a significant difference (P <.001). The length of hospital stay ranged from 12 to 48 hours. The period of follow-up ranged from 6 months to 12 years (mean, 4.9 years). Kaplan-Meier curves of groups A and B are not different, as determined by means of log-rank analysis. No aneurysm formation was encountered. Conclusions The results of balloon angioplasty for native coarctation in both selected children and adults are excellent. In recoarctation, we recommend balloon angioplasty in the pediatric patients. (Am Heart J 2002;144:180-6.)

Balloon angioplasty of coarctation of the aorta: A safe alternative for surgery in adults: Immediate and mid‐term results

Patients with coarctation of the aorta can be treated either with surgery or with balloon angioplasty. So far, the last method has proved to be successful in children, but results of this treatment in (young) adults are virtually unknown. The aim of this study was to evaluate the immediate and mid-term follow-up results of balloon angioplasty of native coarctation in (mainly young) adults. Coarctation of the aorta was diagnosed by means of ultrasound or angiography, and defined as a stenosis with a pressure gradient greater than 20 mm Hg. The balloon angioplasty-procedure was carried out under complete anesthesia, and was considered to be successful, if the pressure gradient was reduced to less than 20 mm Hg. Nineteen consecutive adults (12 males, 7 females; aged 14–67 years, median 29) with native coarctation were treated from 1995–99. Mean pressure gradient decreased from 49.3 ± 20.8 to 4.8 ± 8.2 mm Hg (P < 0.0001). One patient showed a suboptimal result with a residual pressure gradient of 28 mm Hg. In one other patient a stent was placed on request of the referring physician. Follow-up was 100% complete and ranged from 3–47 months (mean 20.2 ± 12.9). At 1-year follow-up mean systolic blood pressure was reduced from 159.4 ± 19.5 to 132.5 ± 17.6 mm Hg (n = 18; P < 0.0001), and mean ankle-arm pressure index improved from 0.73 ± 0.09 to 0.96 ± 0.05 (n = 18; P < 0.0001). Anti-hypertensive medication could either be reduced or stopped in 7 patients (53.8%). With ultrasound or angiography or MRI, no patients had signs of aneurysm formation or worsening restenosis during follow-up. In adult patients with uncomplicated native coarctation of the aorta, balloon angioplasty (without stenting) would seem to be an excellent and safe alternative for surgery. In our hospital it has completely replaced surgical correction in such patients. Cathet. Cardiovasc. Intervent. 50:28–33, 2000. © 2000 Wiley-Liss, Inc.

Balloon angioplasty of native coarctation: clinical outcomes and predictors of success

OBJECTIVESWe sought to investigate the clinical impact of balloon angioplasty for native coarctation of the aorta (CoA) and determine predictors of outcome.BACKGROUNDBalloon dilation of native CoA remains controversial and more information on its long-term impact is required.METHODSHemodynamic, angiographic and follow-up data on 69 children who underwent balloon angioplasty of native CoA between 1988 and 1996 were reviewed. Stretch, recoil and gain of CoA circumference and area were calculated and related to outcomes.RESULTSInitial systolic gradients (mean ± SD, 31 ± 12 mm Hg) fell by −74 ± 27% (p < 0.001), with an increase in mean CoA diameters of 128 ± 128% in the left anterior oblique and 124 ± 87% in the lateral views (p < 0.001). Two deaths occurred, one at the time of the procedure and one 23 months later, both as a result of an associated cardiomyopathy. Seven patients had residual gradients of >20 mm Hg. One patient developed an aneurysm, stable in follow-up, and four patients had mild dilation at the site of the angioplasty. Freedom from reintervention was 90% at one year and 87% at five years with follow-up ranging to 8.5 years. Factors significantly associated with decreased time to reintervention included: a higher gradient before dilation, a smaller percentage change in gradient after dilation, a small transverse arch and a greater stretch and gain, but not recoil.CONCLUSIONBalloon dilation is a safe and efficient treatment of native CoA in children. Greater stretch and gain are factors significantly associated with reintervention, possibly related to altered elastic properties and vessel scarring.

Initial results and clinical follow-up after balloon angioplasty for native coarctation

This study describes the initial hemodynamic results and early to late clinical follow-up, including magnetic resonance imaging and exercise testing, following balloon angioplasty for native coarctation of the aorta. We advocate this approach as an alternative to surgical intervention in select patients based on age, aortic arch anatomy, or in those patients who have coexisting cardiac defects that are amenable to transcatheter intervention.

Interventional catheterization decreases plasma levels of atrial natriuretic peptide (ANP) in children with congenital heart defects.

Atrial natriuretic peptide (ANP) is one of the cardiac peptides implicated in volume and sodium homeostasis. We investigated the effect of interventional catheterization on plasma levels of ANP, aldosterone, and cortisol in 28 children with various congenital heart defects (CHD). Patients were divided by age into two groups: group A--infants and children over 3 months of age (n = 22), and group B--newborns (n = 6). These were compared to age-matched control groups. In group A, interventions included pulmonic valvotomy (n = 8), aortic valvotomy (n = 4), balloon angioplasty of native coarctation of the aorta (n = 3), balloon dilatation of the mitral valve (n = 1), and Rashkind double umbrella closure of patent ductus arteriosus (n = 6). Group B interventions included pulmonic valvotomy (n = 3), aortic valvotomy (n = 1), and balloon atrial septosomy (n = 2). In group A, mean ANP levels were markedly higher than in age-matched controls (125.2+/-15.8 vs. 24.6+/-4.6 pg/ml) (P <0.0001), and decreased immediately after intervention (75.6+/-11.4 pg/ml, P <0.02), and more markedly on follow-up (42.9+/-5.0 pg/ml, P < 0.0001). In group B (newborns), mean basal plasma levels were high before and after intervention and were not different from age-matched controls (243+/-42.1 vs. 220.8+/-16.2 pg/ml). There was a significant decrease on follow-up measurement (62.1+/-12.7 pg/ml, P < 0.005). In both groups, plasma cortisol levels increased significantly immediately following catheterization (P < 0.02), and normalized on follow-up. Basal aldosterone levels were normal in group A and high in Group B (9.9+/-3.8 vs. 167.6+/-16.9 ng/dl) (P < 0.001). It is suggested that plasma ANP levels are increased in children with CHD, without overt heart failure, and decrease significantly following successful intervention. In newborns with CHD, the physiological high ANP levels obscure the effect of the CHD.

Relation of biophysical response of coarcted aortic segment to balloon dilatation with development of recoarctation following balloon angioplasty of native coarctation

ObjectiveTo evaluate the role of biophysical response of the coarcted segment to balloon dilatation in the causation of aortic recoarctation.SettingTertiary care centre/university hospital.DesignRetrospective case series.MethodsRecords of 67 consecutive infants and...

Balloon Angioplasty of Native Coarctation of the Aorta in Adolescents and Adults: Longterm Results

Balloon Angioplasty of Native Coarctation of the Aorta in Adolescents and Adults: Longterm Results

Balloon angioplasty of native coarctation of the aorta in adolescents and adults: longterm results

Balloon angioplasty of native coarctation of the aorta in adolescents and adults: longterm results

One- to Ten-Year Follow-Up Results of Balloon Angioplasty of Native Coarctation of the Aorta in Adolescents and Adults

Objectives. We attempted to evaluate the role of balloon angioplasty in the treatment of discrete coarctation of the aorta in adolescents and adults, with special emphasis on long-term results.Background. Controversy persists over the use of balloon dilation for the treatment of native coarctation of the aorta.Methods. Between July 1986 and January 1997, 43 consecutive adolescent and adult patients with discrete coarctation of the aorta underwent balloon angioplasty. One- to 10-year follow-up data of 37 patients, including results of cardiac catheterization and magnetic resonance imaging (MRI), form the basis of this study.Results. No early or late deaths occurred. Balloon angioplasty produced a reduction in the peak to peak coarctation gradient from a mean ± SD of 69 ± 24 mm Hg (95% confidence interval [CI] 61 to 76) to 12 ± 8 mm Hg (95% CI 10 to 14.8) (p < 0.001). Follow-up catheterization 12 months later (37 patients) revealed a residual gradient of 6.7 ± 6 mm Hg (95% CI 4.6 to 8.9); 3 (7%) of 43 patients had suboptimal results with development of recoarctation, defined as peak gradient >20 mm Hg, with successful repeat angioplasty. A small aneurysm developed at the site of dilation in 3 (7%) of the 43 patients. MRI follow-up data 1 to 10.8 years (mean 5.2 ± 2.7) after angioplasty (37 patients) revealed no new aneurysm or appreciable change in the size of the preexisting aneurysm in the three patients. The blood pressure had normalized without medication in 27 (73%) of 37 patients at follow-up examination.Conclusions. Balloon angioplasty is safe and effective and should be considered a viable alternative to operation for treatment of discrete coarctation of the aorta in adolescents and adults.

Acute Results of Balloon Angioplasty of Native Coarctation Versus Recurrent Aortic Obstruction Are Equivalent

This study sought to compare the immediate results and risk factors for suboptimal outcomes of percutaneous balloon angioplasty for native versus recurrent aortic obstruction. Some cardiology centers have been reluctant to adopt balloon angioplasty for treatment of native aortic coarctation, while advocating balloon angioplasty over an operation for treatment of postsurgical or recurrent aortic obstruction. Acute results were analyzed from 970 procedures (422 native and 548 recurrent lesions) performed between 1982 and 1995 in 907 patients from 25 centers. An acute suboptimal outcome was defined as one or more of the following: residual systolic pressure gradient > or = 20 mm Hg, residual proximal to distal systolic pressure ration > or = 1.33 or a major complication (death, aortic transmural tear, stroke). Bal loon angioplasty significantly (p = 0.0001) increased lesion diameter fo r both native (mean [+/= SD] 128 +/= 94%) and recurrent aortic obstruction (97 +/= 87%), with a significantly greater increase in the native group (p = 0.0001). A reduction in systolic pressure gradients was significant in both groups (p = 0.0001), but slightly higher (p = 0.01) for native (-74 +/- 24%) versus recurrent obstruction (-70 +/- 31%). Death associated with angioplasty was reported in 0.7% of patients with native and in 0.7% of patients with recurrent lesions (p = 1.00). An acute suboptimal outcome was noted with angioplasty in 19% of native and in 25% of recurrent lesions (p = 0.04). Significant independent risk factors included higher preangioplasty systolic gradient (odds ratio [OR] 1.39/10-mm Hg increment; 95% confidence interval [CI] 1.28 to 1.50, p = 0.0001), earlier study date (OR 0.92/1-year increment, 95% CI 1.02 to 1.26, p = 0.02) and recurrent obstruction (OR 1.39 vs. native lesions, 95% CI 1.00 to 1.94, p = 0.05). Acute results and complications of balloon angioplasty of native coarctation appear to be equivalent or slightly superior to those of recurrent aortic obstructions.

Quantitative echocardiographic analysis of the aortic arch predicts outcome of balloon angioplasty of native coarctation of the aorta.

The use of balloon angioplasty for treatment of native aortic coarctation is controversial. Cineangiographic data suggest that aortic arch hypoplasia and isthmic narrowing are associated with angioplasty failure. This study of echocardiographic measurements of preangioplasty aortic arch morphology was performed to identify potential anatomic predictors of outcome noninvasively. The preangioplasty echocardiograms of 105 patients 3 days to 17 years old with native coarctation of the aorta were analyzed off-line. Angioplasty was considered successful if the residual coarctation gradient was < 20 mm Hg and no intervention for recoarctation occurred. Univariate analysis identified young age at angioplasty, presence of a patent ductus arteriosus, and the diameters of the aortic isthmus, distal transverse arch, and aortic valve as predictors of early and late outcomes. Multivariate analysis showed that the preangioplasty aortic isthmus z value was the best independent predictor of outcome, eliminating the effect on outcome of age and associated cardiac defects. An isthmus z value < or = -2.16 predicted early failure with 91% sensitivity and 85% specificity. Kaplan-Meier analysis demonstrated that 90% of patients with an isthmus z value > -1.0 remained free of recoarctation at late follow-up, whereas 89% of patients with a preangioplasty isthmus z value < or = -2.0 developed recoarctation within 36 months. Echocardiographic measurements of the aortic arch predict both early and late outcomes of balloon angioplasty for native aortic coarctation, and the preangioplasty aortic isthmus z value was the best independent predictor. Quantitative aortic arch analysis may improve selection of angioplasty candidates who are likely to benefit from the procedure.

BIOPHYSICAL RESPONSE OF COARCTED SEGMENT TO BALLOON DILATATION DETERMINES RECOARCTATION IN NATIVE COARCTATIONS. 195

Although causes of recoarctation following balloon angioplasty of native aortic coarctation have been examined in terms of demographic, anatomic, hemodynamic and technical variables, role of biophysical response of the coarcted segment to balloon stretch in the genesis of recoarctation has not been studied. Sixty-seven consecutive infants and children undergoing balloon angioplasty of native coarctations during an 8.7-year-period ending September 1993 were included in the study. Immediate reduction (p 20 mmHg. Stretch ([Balloon circumference - pre-balloon coarcted segment circumference/pre-balloon coarcted segment circumference] × 100), gain(post-balloon coarcted segment circumference - pre-balloon coarcted segment circumference) and recoil (balloon circumference - post-balloon coarcted segment circumference) were calculated from measurements obtained from cineangiograms performed prior to and immediately after balloon dilatation. The percent stretch in 44 children without recoarctation (218 ± 123%) was similar (p > 0.1) to that in 15 children with recoarctation (190± 65%) implying that similar balloon dilating force was applied in both groups. Greater (p < 0.001) gain was observed in the group without recoarctation (15.4 ± 9.1 mm) than in the recoarctation group (9.8± 4.6 mm). Surprisingly the recoil was higher (p < 0.01) in the group without recoarctation (9.1 ± 6.3 mm) than in the recoarctation group (4.1 ± 2.9 mm). These differences remained significant even after normalizing the gain and recoil to the extent of stretch and controlling for covariate effects of stretch (i.e. the coarcted segment and balloon sizes) on gain and recoil. Higher gain and recoil in the group without recoarctation implies preservation of intact elastic tissue in the coarcted segment. In the recoarctation group, with less gain and recoil, the elastic properties may not have been preserved, thereby causing recoarctation. Different degrees of cystic medial necrosis (depletion and disarray of elastic tissue) have been described in excised coarcted segments, and there may be more severe degrees of cystic medial necrosis in recoarctation group than in no recoarctation group.

Late development of dissecting aneurysm following balloon angioplasty of native aortic coarctation

Acute aortic dissection during balloon angioplasty for coarctation of the aorta or aneurysm formation during follow-up are well-known complications of this procedure. Dissecting aneurysm development during long-term follow-up after balloon angioplasty of a native coarctation has not been previously reported. We report a case in which a huge dissecting aneurysm developed 3 years after the native coarctation angioplasty procedure. The aneurysm required surgical repair.

Balloon angioplasty for native coarctation of the aorta.

Balloon angioplasty of native coarctations of the aorta is one of the most controversial facets of the pediatric interventional cardiologist's practice. We have evaluated the history and experimental rationale of this technology. Presently accepted techniques are outlined and controversies intrinsic in performance of this procedure are discussed. Acute, short-term, and long-term results are reviewed with particular emphasis on differences in success of the procedure as related to patient age. Common and significant complications are discussed and in some cases compared to analogous surgical complications. Newer technologies and approaches to interventional therapy for coarctation of the aorta are also discussed.

Validation of risk factors in predicting recoarctation after initially successful balloon angioplasty for native aortic coarctation

Despite gratifying immediate results, significant recoarctation at follow-up has been observed after balloon angioplasty of native aortic coarctation. Risk factors for such recurrences have been identified in one of our previous studies. In this study we examined the value of these risk factors in the prediction of recoarctation after balloon angioplasty. During a 6-year period ending in September 1993, 37 infants and children aged 2 days to 15 years underwent balloon angioplasty of native coarctation with resultant reduction in coarctation gradient from 45 ± 17 (mean ± SD) to 12 ± 9 mm Hg ( p < 0.001). On the basis of results of 4- to 48-month follow-up catheterization in 30 children, recoarctation developed in 8 (27%) children. The data from these patients were scrutinized to identify subjects that exhibited the previously determined risk factors, namely age <12 months, size of aortic isthmus less than two thirds the size of the ascending aorta, coarcted aortic segment <3.5 mm before angioplasty, and coarcted segment <6.0 mm after angioplasty. Then, thirty variables (Table I) were examined by logistic regression to identify factors responsible for recoarctation; the data from both study groups were combined for this analysis. The prevalence of recoarctation in each subgroup with a given number of risk factors is similar ( p < 0.1) to that observed in the initial study identifying the risk factors. In addition, logistic regression identified age ( p = 0.014), size of isthmus ( p = 0.006), preangioplasty coarcted segment ( p = 0.01), and postangioplasty coarcted segment ( p = 0.006) as risk factors. The younger the age, the narrower the aortic isthmus, and the smaller the coarcted segment (both before and after angioplasty), the greater the chance for recoarctation. In conclusion, the data from this study validate the reliability of previously identified risk factors in predicting recoarctation after balloon angioplasty of native coarctation. Identification of risk factors may help in selection of patients for balloon angioplasty.

Balloon angioplasty of native coarctation of the aorta: Midterm follow-up and prognostic factors

OBJECTIVES, This retrospective analysis was designed to examine the intermediate and long-term effects of balloon angioplasty for native coarctation of the aorta and to determine whether any factors are predictive of outcome. Balloon angioplasty for native coarctation of the aorta is controversial. Concerns exist over lack of long-term follow-up and possible formation of aneurysms. The role of transverse arch and isthmus hypoplasia after balloon dilation is unknown. Included in the study were all patients 3 days to 29 years old (mean age 4.6 years) referred for possible balloon dilation to the pediatric cardiac catheterization laboratory with evidence of a discrete coarctation of the aorta. The hemodynamic data, angiograms and clinical records of 102 patients were examined, with follow-up data from 2 to 117 months (median 36.2) available in 92 patients. Immediate success with balloon angioplasty was achieved in 93 (91.2%) of the 102 patients. Seventy-one patients (77.2%) with intermediate follow-up data (range 12 to 117 months) available are asymptomatic and normotensive, with insignificant arm to leg blood pressure gradients (< or = 20 mm Hg). Twenty-one patients (22.8%) with an initial successful result developed an increase in gradient 2 at 86 months after angioplasty, requiring reintervention in 18. Follow-up > 72 months is available in 17 patients, 16 of whom are normotensive and have not required additional intervention. No additional intervention was needed in 88.4% of older children and infants > 7 months old. Ten of the 13 surviving neonates who initially had a successful dilation required reangioplasty or operation 14 days to 10 months (median 4.6 months) after angioplasty. Transverse arch hypoplasia had minimal effect on follow-up blood pressure gradient, whereas isthmic hypoplasia was associated with reintervention in 50%. A small aneurysm was noted in 2 (1.9%) of 102 patients. Balloon angioplasty of native aortic coarctation is effective in infants and older children. In neonates, balloon angioplasty provides effective palliation only. Aneurysm formation is rare; however, lifetime follow-up is warranted.

721-4 Quantitative Echocardiographic Analysis of Aortic Arch Morphometry Predicts Outcome of Balloon Angioplasty of Native Coarctation of the Aorta

To determine whether quantitative analysis of aortic arch morphometry can predict outcome of balloon angioplasty (BA) of native coarctation of the aorta (COA), we reviewed pre-angioplasty echocardiograms available on 105 patients undergoing BA from 1983–1994. Multiple aortic arch measures were digitized off-line and indexed to BSA. Patients were categorized as angioplasty successes (residual systolic gradient &lt; 20 mmHg and freedom from in tervention for recoarctation) or failures at immediate (0-1 mo.). intermediate (1–72 mos.) and long-term ( &gt; 72 mos.) follow-up (FU) intervals. Comparisons between categories of arch measures were performed for each FU interval At immediate FU, the following differences between outcome categories were observed: Echo Measurement Success (n = 83) Failure (n = 22) P value Aortic Annulus (cm/BSA 0.5 ) 1.48 ± 020 135 ± 023 &lt; 0.025 Distal Aortic Arch (cm/BSA 0.5 ) 115 ± 020 095 ± 0.17 &lt;00001 Isthmus Icm/BSA 0.5 ) 1.04 ± 0.17 0.79 ± 0.10 &lt;00001 Isthmus z-score -1.14 ± 0.98 -2.61 ± 0.53 &lt;00001 Isthmic Volume (ml/BSA 1.5 ) 0.63 ± 0.35 0.30 ± 0.20 &lt;0.0001 Coarctation Site (cm/BSA 0.5 ) 0.54 ± 014 0.49 ± 0.10 NS Isthmus/Descending Aorta 0.91 ± 0.18 0.68 ± 0.14 &lt;0.0001 At intermediate FU, the above variables achieved similar statistical significance in describing differences between success (n = 54) and failure (n = 21). Logistic regression analysis using isthmus z-score yielded a prediction model P (Fail) = (1 +e -6.22-2.39Z )- 1 in the immediate group. An isthmus zscore ≤ -2.16 predicted failure (91% sensitivity, 85% specificity). In the intermediate FU group, stepwise logistic regression with aortic annulus, isthmus z-score and coarctation site/isthmus ratio yielded a model predicting failure with 91% sensitivity and 81% specificity. Though less sensitive (39%), echocardiographic presence of patent ductus arteriosus was a highly specific (93%) predictor of failure at immediate and intermediate FU, with positive predictive value of 81%. A single patient failed during the long-term FU interval Quantitative echocardiographic analysis of aortic arch morphometry predicts outcome of BA of native COA. These data may improve selection of candidates for BA

Acute life-threatening hypertension following balloon angioplasty of native coarctation of the aorta

Acute life-threatening hypertension following balloon angioplasty of native coarctation of the aorta

Transumbilical balloon coarctation angioplasty in neonates with critical aortic coarctation

Balloon angioplasty of previously unoperated, “native,” aortic coarctation has been successfully used in neonates and infants younger than 1 year of age.l-14 Symptomatic improvement and pressure gradient reduction after balloon angioplasty14 has been well documented. The high incidence of recoarctation and the potential for development of aneurysms and arterial complieations15-*7 are of concern. We report the feasibility of balloon angioplasty for native coarctation via an umbilical artery approach, which spares the femoral arteries. An 11-day-old infant who weighed 3.9 kg was first seen in the local physician’s office with a 3-day history of upper respiratory tract infection. He was found to be grunting, cyanotic, and poorly perfused. He was immediately ventilated manually and rushed to a local emergency room. There he was intubated, given volume expansion, and started on vasopressor agents; only a transient improvement in color and perfusion was observed. The initial pH was 7.1 with a base deficit of 12.8. Chest x-ray films showed cardiomegaly and evidence of pulmonary venous congestion. Pediatric cardiology consultation along with a Doppler echocardiographic study was obtained immediately. An echocardiogram showed evidence of severe aortic coarctation, mild aortic stenosis, no ventricular septal defect, and poor left ventricular shortening fraction. Because severe aortic coarctation was diagnosed, intravenous prostaglandin Ei infusion was started, and significant improvement occurred over the next 30 minutes of observation. The infant was transferred to the University of Wisconsin Children’s Hospital. After further stabilization in the pediatric intensive care unit, the infant was taken to the cardiac catheterization laboratory. Percutaneous right heart catheterization and antegrade left ventricular angiography, which was performed via the right femoral vein, revealed severe aortic coarctation with a large gradient (Table I) across the aortic coarctation. The coarcted aortic segment measured 2 mm, and the descending aorta at the level of the diaphragm measured 6 mm. Because the need for relief of aortic coarctation was indicated, the previously placed 3.5F umbilical arterial catheter was exchanged for