Balloon Dilation Angioplasty Research Articles

Magnetic resonance imaging of the iliofemoral arteries after balloon dilation angioplasty of aortic arch obstructions in children.

We wished to determine the nature and incidence of changes in the iliofemoral arteries after balloon dilation angioplasty (BDA) for aortic arch obstruction in children and to determine the reliability of gradient magnetic resonance imaging (MRI) in their detection. Sixty-three children, including 62 with and 1 without arch obstruction, underwent MRI of the iliofemoral vessels. Of these, 36 patients had undergone transfemoral BDA (7 after previous transfemoral diagnostic catheterization), 12 had undergone diagnostic transfemoral catheterization but not BDA, and 15 had no history of femoral arterial catheterization. The iliofemoral arteries were normal on MRI in all 15 children without catheterization. Among the 36 children who had undergone BDA, the ipsilateral iliofemoral artery was normal in 15, mildly narrowing in 7, and severely stenotic or occluded in 14 (39%), including 6 of 9 patients treated for acute femoral artery thrombosis and 8 with no history of femoral artery thrombosis. Two patients had documentation of progressive obstruction. Six patients had concordant conventional angiography. There was a significant correlation between the number of balloon catheters used for the angioplasty and severe occlusive changes. Nine of 19 patients who had undergone diagnostic transfemoral catheterization had severe obstructive changes on MRI; 8 of 9 weighed < 10 kg at catheterization. Obstructive lesions of the iliofemoral arteries are common after transfemoral BDA of arch obstructions (58%) and can be reliably evaluated with gradient MRI. Catheter size and manipulation are the main contributing factors.

Abdominal aortic coarctation treated with percutaneous transluminal angioplasty: a case report

Abdominal aortic coarctation is a rare congenital vascular by nosis of abdominal aorta. Surgical management may be complex. This paper application of balloon dilation angioplasty in a case of abdominal aortic coarctation.

Balloon Dilation Angioplasty of Aortic Coarctation in Adult

Balloon Dilation Angioplasty of Aortic Coarctation in Adult

A case report of balloon dilatation angioplasty of coarctation of the aorta in a young adult

A case report of balloon dilatation angioplasty of coarctation of the aorta in a young adult

Coarctation: Do we need to resect ductal tissue?

A review of the literature as well as a retrospective review of 100 neonates undergoing operation for coarctation at Children's Hospital in Boston between 1972 and 1984 has not established clear superiority for either resection and end-to-end anastomosis or subclavian flap aortoplasty with respect to risk of recurrent coarctation. However, there is histological evidence that the juxtaductal coarctation shelf is composed of smooth muscle of ductal origin, which subsequently fibroses. This abnormal tissue may be at risk for late aneurysm development, particularly if balloon dilation angioplasty is required. The fact that this abnormal tissue is not removed by the subclavian flap procedure is one of the inherent disadvantages of that procedure. Other disadvantages include the need to sacrifice the left subclavian artery and the fact that, unlike resection and end-to-end anastomosis, the subclavian flap procedure does not lend itself to augmentation of the hypoplastic distal aortic arch. Furthermore, occasionally a secondary coarctation membrane is present within the distal aortic arch, and though it is readily detected during the resection procedure, it can be missed with the subclavian flap procedure. Based on these considerations rather than on a demonstrated superiority of either procedure, my colleagues and I currently prefer resection and end-to-end anastomosis over subclavian flap aortoplasty.

Iliofemoral arterial complications of balloon angioplasty for systemic obstructions in infants and children.

The medical and radiological records of 64 consecutive infants and children who underwent transfemoral balloon dilation of the aorta or aortic valve were reviewed to determine the incidence, nature, and post-treatment outcome of acute iliofemoral complications. Balloon dilation angioplasty or balloon valvotomy was performed with 8F and 9F catheters without an arterial sheath. Patients ranged in age from 5 days to 15.4 years (mean, 6.4 years). Of 64 patients, 29 (45.3%) had an acute iliofemoral complication, including thrombosis (18 of 64), complete disruption (five of 64), incomplete disruption (three of 64), and arterial tear (three of 64). The arterial pathology was confirmed in 23 of 29 patients by one or a combination of surgical exploration and repair (18 of 29), angiography (six of 29), and magnetic resonance imaging (three of 29). Of eight patients, three with arterial disruption had acute hypotension requiring transfusion and immediate surgery; the other five had absent pedal pulses after the procedure. Of these five, three developed bleeding during thrombolytic therapy and underwent surgical exploration, and two were diagnosed by angiography after ineffective thrombolytic therapy. Angiography in three patients with iliac artery avulsion showed tapered occlusion in two and an aneurysm in one. In patients with iliofemoral thrombosis, angiography showed occlusion from the puncture site to the origin of the external iliac artery. Eleven patients (17% of the entire group and 38% of the group with acute iliofemoral complications) had reduced or absent pedal pulses at the time of discharge. A significant correlation was found between increased incidence of iliofemoral thrombosis and disruption (as well as abnormal pedal pulses at hospital discharge) and low patient weight.

Intravascular ultrasound cross-sectional arterial imaging before and after balloon angioplasty in vitro.

A prototype ultrasound imaging catheter was evaluated in vitro using 17 human atherosclerotic artery segments before and after balloon dilatation angioplasty. The catheter was 1.2 mm in diameter and incorporated a single 20-MHz ultrasound transducer to obtain cross-sectional images of the arterial lumen. In 15 of the 17 (88%) arteries, high quality images were obtained, which demonstrated clear demarcation between the lumen and the endothelium, the atheroma plaque, the muscular media, and the adventitia. Qualitative characteristics of plaque disruption, dissection, and residual flaps were readily visible. In addition, quantitative information about cross-sectional lumen area was obtained before and after balloon dilatation. The mean cross-sectional lumen area increased from 8.7 to 15.1 mm2 (p less than 0.01) following balloon dilatation. The lumen area measured from the ultrasound images following dilatation correlated closely with the area measured from histologic sections (r = 0.88). The results from this study indicate that a small-diameter ultrasound imaging catheter can be developed that will provide high-resolution qualitative and quantitative information during peripheral and coronary angioplasty.

Treatment of recoarctation: Balloon dilation angioplasty

Balloon dilation of recoarctation of the aorta was performed 47 times in 44 patients 49 ± 54 months after surgical repair. The initial operation was performed in the neonatal period in 29 patients (66%). The age at balloon dilation was 4.9 ± 5.3 years (range 2 months to 20 years) and weight was 18 ± 15 kg (range 2 to 72). Systolic pressure difference across the recoarctation site decreased from 37 ± 16 to 14 ± 11 mm Hg and coarctation/aortic diameter ratio increased from 0.45 ± 0.14 to 0.85 ± 0.16 immediately after balloon dilation regardless of the nature of the previous operation (subclavian flap [n = 12], resection with end to end anastomosis [n = 21], patch angioplasty [n = 4] or multiple operations [n = 5]). In the ascending aorta, systolic pressure decreased from 120 ± 25 to 113 ± 20 mm Hg. In the descending aorta, systolic pressure increased from 85 ± 15 to 100 ± 19 mm Hg and pulse pressure increased from 22 ± 7 to 36 ± 8 mm Hg.At repeat cardiac catheterization in 21 patients (48%) 12 ± 8 months after balloon dilation, there was further reduction in systolic pressure difference from 17 ± 11 to 12 ± 9 mm Hg with no further change in coarctation/ aortic diameter ratio. Aneurysm formation was evident in one patient (2%) immediately after balloon dilation; the aneurysm was unchanged at repeat study 15 months later. A “new” aneurysm was apparent in 2 (10%) of the other 20 patients restudied to date. The occurrence of aneurysm in these three patients was unrelated to balloon size. There were no procedure-related deaths. Three patients (7%) had femoral artery occlusion. Balloon dilation affords good relief of obstruction without adverse sequelae from aortic wall disruption at medium-term follow-up.

A case report of balloon dilatation angioplasty of stenotic pulmonary artery

A case report of balloon dilatation angioplasty of stenotic pulmonary artery

Balloon dilation angioplasty of Blalock-Taussig shunts

Balloon dilation angioplasty has been successful in the treatment of aortic 1 and pulmonary artery stenoses. 2 To date, a single report of successful dilation of a Blalock-Taussig (B-T) shunt has been published. 3 This report reviews the technique and results of dilation of B-T shunts in 6 patients.

Plasma catecholamine responses to balloon angioplasty in children with coarctation of the aorta

The postoperative increase in blood pressure after surgical correction of coarctation of the aorta is a well-recognized and potentially dangerous phenomenon 1,2. Elevations of both the renin-angiotensin system 3 and sympathoadrenal activity 1,4,5 have been identified in the pathogenesis of this paradoxical hypertension. Balloon dilation angioplasty is being increasingly used as a nonsurgical method for relief of coarctation of the aorta. 6,7 Postdilation hypertension has been reported only rarely. 8 Recently, Choy et al 9 have reported that plasma catecholamines and renin activity increased in patients undergoing surgical relief of coarctation but were not significantly increased after balloon angioplasty. Plasma catecholamine concentrations, however, were obtained at least 1 day after balloon dilation. In view of the potential for sympathetic activity to increase immediately and cause paradoxical hypertension within the first few hours after the procedure, 5 we determined plasma catecholamine concentrations immediately after balloon angioplasty.

Balloon valvuloplasty for pulmonic valve stenosis—two‐year follow‐up: Hemodynamic and doppler evaluation

The purpose of this investigation was to evaluate the efficacy, technique, and follow-up results of balloon dilation angioplasty for valvular pulmonary stenosis. Percutaneous dilation was performed on 63 patients with pulmonary stenosis (ages 3 months to 76 years, mean = 4.3 years). In 43 patients, a single balloon was used; in 20 patients two balloons were used simultaneously. The pressure gradient across the pulmonary valve was determined with right ventricular and main pulmonary artery catheters. Pressure gradients simultaneously were estimated by continuous wave Doppler (CWD) during catheterization. The peak systolic ejection gradient was obtained by both techniques both pre- and postangioplasty. There was excellent linear correlation between the simultaneous catheter pressure gradient and the pressure gradient estimated by Doppler (r = 0.99). Follow-up pressure gradient estimations by Doppler echocardiogram were obtained in 30 patients between 6 months and 30 months postcatheterization (mean = 13 months). The mean preangioplasty gradient of 64 mm Hg (range 30-160 mm Hg) was reduced to 22 mm Hg (range 2-31 mm Hg). A significant reduction of transvalvular gradient (52-95%, mean 68%) occurred in each patient. A linear correlation was found between the predilation gradient and the pressure gradient drop (r = 0.92). Mean follow-up gradient by Doppler was 20 mm Hg (range 0-31 mm Hg), and there was no significant difference between these gradients and the postdilation gradient. No important complications were noted. These data confirm that balloon dilation angioplasty for valvular pulmonary stenosis is safe and effective, and suggest that stenosis does not recur.

Balloon dilation angioplasty of postoperative aortic obstructions

Balloon dilation angioplasty (BDA) was attempted 29 times in 27 patients, aged 3 months to 22 years, with postoperative aortic obstructions. Previous operations included end-to-end anastomosis (n = 10), subclavian flap angioplasty (n = 7) and patch angioplasty (n = 3) for aortic coarctation, end-to-end anastomosis for interrupted aortic arch type B (n = 4) and aortic arch reconstruction for hypoplastic left heart syndrome (n = 3). Two of the patients with interrupted arch had multiple areas of obstruction. Balloon sizes were between 2 and 6 times the diameter of the lesion and up to twice the diameter of the proximal transverse arch (mean 1.1). BDA was at least partially successful (more than 50% decrease in gradient and more than 30% increase in diameter) in 26 of the 29 procedures (90%). BDA failed in the 2 lesions with an initial diameter of more than 8 mm. No differences were apparent In the success rate among any of the clinical groups. Peak systolic gradient decreased from 42 ± 14 to 14 ± 15 mm Hg (p < 0.01) and mean diameter increased from 4.1 ± 2.6 to 6.8 ± 3.2 mm (p <0.01). There was no mortality or significant acute morbidity associated with the procedure. After 1 to 24 months of follow-up, restenosis has occurred in only 1 patient. Aneurysm formation was found in 2 of 5 patients who had undergone repeat catheterization; both aneurysms occurred in patients with repaired interruption of the aortic arch. Thus, BDA can be both safe and effective in acutely relieving the gradient and stenosis in most forms of postoperative aortic obstruction. The incidence and significance of late recurrence (more than 2 years) or aortic aneurysms is unknown; these potential complications must be evaluated In every patient after BDA.

Percutaneous balloon dilation angioplasty of pulmonary artery branch stenosis.

Congenital or acquired branch pulmonary artery stenosis can produce significant right ventricular hypertension and complicate the management of patients with tetralogy of Fallot. Repair is difficult using conventional surgical techniques. Balloon dilation angioplasty may be beneficial to some patients with these lesions. The technique currently used at the University of Minnesota is described. Results indicate that half of attempted dilations are successful with increased diameter of the narrowed areas, decreased pressure gradient, and improved pulmonary blood flow to the involved lung. Failure may be caused by technical limitations (28%) or lesions that are not dilatable with current equipment (22%). Undilatable lesions are more common in children over 2 years of age, in isolated pulmonary artery stenosis, and with associated surgical shunts. Complications are uncommon.

Management of congenital stenosis of a branch pulmonary artery with balloon dilation angioplasty: J.C. Ring, J.L. Bass, W. Marvin, et al. J. Thorac Cardiovasc Surg 90:35–44, (July), 1985

Management of congenital stenosis of a branch pulmonary artery with balloon dilation angioplasty: J.C. Ring, J.L. Bass, W. Marvin, et al. J. Thorac Cardiovasc Surg 90:35–44, (July), 1985

Nuclear magnetic resonance imaging in evaluation and follow-up of children treated for coarctation of the aorta

Electrocardiographic-gated nuclear magnetic resonance imaging was used to evaluate 10 patients, aged 2.5 to 18 years, with coarctation of the aorta. Six patients had balloon dilation angioplasty, one had surgical repair and three are awaiting treatment. Imaging studies were performed before and after therapy in three patients. In all pretreatment studies, the sagittal and 60 degrees left anterior oblique imaging planes adequately revealed the anatomy of the coarctation. Post-treatment imaging studies demonstrated effective relief of the coarctation in all cases. In three of the six patients who had balloon angioplasty, there was a variable degree of dilation of the aorta at the site of the previous coarctation. Nuclear magnetic resonance imaging is an effective noninvasive imaging method for visualizing coarctation of the aorta and for follow-up after treatment.

Balloon dilation angioplasty for coarctation of the aorta

Eleven patients with coarctation of the aorta (C of A) underwent balloon dilation angioplasty at the University of Arizona from November 1983 to January 1985. Eight had previously undergone surgery and 3 had native C of A. Two operations were considered unsuccessful: 1 in a patient who underwent tube graft-descending aortic anastomosis narrowing and 1 in a patient with a native wedge type of C of A. Overall mean gradient fell from 47 to 13 mm Hg immediately after the procedure. Mean gradient at repeat catheterization in 7 patients (mean 8 months after angioplasty) was 6 mm Hg. Five patients showed a transient increase in the gradient measured on the day after angioplasty, with 3 showing a fairly marked increase. Values returned to levels equal to or less than gradients measured immediately after the procedure. Angiographic findings at follow-up catheterization in 7 patients showed no evidence of aneurysm formation in either the operative group or in the 2 patients with native C of A who had a membrane type of deformity. Mean C of A to ascending aortic diameter ratios increased from 0.44 to 0.80. At repeat angiography, the mean ratio was 0.76 in the 7 patients studied. Further longitudinal studies in these patients are necessary before reaching conclusions about the advantage of this procedure over surgery, but these early longitudinal results are encouraging for the populations studied: postoperative patients and patients with native membrane types of C of A.

Balloon valvuloplasty and angioplasty in congenital heart disease.

Balloon dilatation valvuloplasty was performed in 16 patients with pulmonary valve stenosis aged 10 days to 17 years. Gradients were reduced in all but two patients and were less than or equal to 20 mm Hg after the procedure in all but these two and one other. Unsatisfactory initial results in these three patients were attributed to the use of too small a balloon in one patient (gradient subsequently abolished at repeat valvuloplasty), to a dysplastic valve in a neonate, and to the fact that there had been a previous surgical valvotomy with scar tissue formation in one patient. The good result was retained in six of seven patients followed up at three to six months. In one the gradient, having been reduced from 60 to 18 mm Hg, had risen to 35 mm Hg. Repeat valvuloplasty was technically impossible in this patient, but in two others residual gradients of 24 and 22 mm Hg were reduced to 4 and 8 mm Hg respectively by repeat valvuloplasty. Balloon dilatation angioplasty was successful in dilating a severe stenosis at the lower limb of an atrial baffle (previous correction of complete transposition) and in dilating supravalvar stenosis of the pulmonary artery resulting from previous banding and debanding. Thus balloon pulmonary valvuloplasty, though still a new technique, appears to be the treatment of choice in patients with typical pulmonary stenosis and thin mobile valves. Patients with dysplastic valves may be less suitable candidates for the procedure. Balloon angioplasty is likely to have other applications, including the treatment of postoperative stenotic lesions.

Management of congenital stenosis of a branch pulmonary artery with balloon dilation angioplasty: Report of 52 procedures

Twenty-four children, aged 4 months to 16 years (nine patients 2 years old or younger), underwent balloon dilation angioplasty of hypoplastic or stenotic branch pulmonary arteries between July, 1981, and April, 1984. Most children had tetralogy of Fallot, with or without pulmonary atresia, or isolated peripheral pulmonary artery stenosis. Fifty-two dilations were attempted, 44 in the catheterization laboratory and eight in the operating room. Of these, 26 (50%) were judged successful; the average vessel diameter on angiogram increased from 4.1 +/- 0.3 to 7.2 +/- 0.3 mm (76%), the gradient across the narrowed segment fell from 60 +/- 10 to 36 +/- 5 mm (40%), pressure in the main pulmonary artery or right ventricle proximal to the obstruction decreased from 83 +/- 10 to 66 +/- 6 mm Hg (20%), and the radionuclide-determined fraction of cardiac output directed to the lung ipsilateral to the dilated pulmonary artery increased from 40 +/- 4 to 51 +/- 4 (28%). All changes were significant at the p less than 0.005 level. Reasons for failure included inadequate technique (balloon too small, inability to position balloon or wire) in 14 and the refractory nature of the lesion itself in 11. Technical failures were age independent. Nondilatable lesions were more common in children more than 2 years old (10/25 versus 1/10) or with isolated peripheral pulmonary artery stenosis (5/7). Five of seven stenoses near previous shunts were nondilatable. One child exsanguinated when the pulmonary artery ruptured during dilation, but other complications were few. Eight dilations, followed up for an average of 6 months after dilation, showed angiographic persistence of improvement; two of four lesions were successfully redilated to a larger size. Balloon dilation angioplasty appears beneficial, both short and long term, for some patients with hypoplastic or stenotic branch pulmonary arteries, especially if performed early in life.

Balloon dilatation angioplasty: nonsurgical management of coarctation of the aorta.

Balloon dilatation angioplasty was successfully performed in five patients (ages 18 months to 17 years) with discrete aortic coarctation. The catheter size was No. 8F or 9F. Selection of balloon diameter was based on angiographic measurements of the aorta determined proximal and distal to the coarctation site. A 10 sec inflation-deflation cycle at 6 to 8 atmospheres (90 to 120 psi) was performed. The systolic pressure gradients across the coarctation before balloon dilatation angioplasty ranged from 35 to 70 mm Hg. Systolic pressure gradients after balloon dilatation angioplasty ranged from 0 to 10 mm Hg. All patients had normalized blood pressure immediately. Abnormal pulsed Doppler echocardiograms were observed in all patients before balloon dilatation angioplasty; four patients had normal echocardiograms after balloon dilatation angioplasty. No serious intraprocedural complications occurred. One patient required femoral artery thrombectomy 36 hr after balloon dilatation angioplasty. One to 6 months after balloon dilatation angioplasty no patients have evidence of restenosis of coarctation. Early results suggest that balloon dilatation angioplasty may offer a safe and effective nonsurgical alternative for the treatment of discrete coarctation in older infants and children. Long-term follow-up for the incidence of restenosis and formation of aneurysms will ultimately determine the efficacy and safety of this procedure.