Balloon Dilation of Aortic Coarctation
Balloon angioplasty has emerged as an alternative to surgery for selected patients with native and recurrent (or residual) coarctation of the aorta. Since the procedureÕs inception in the early 1980s, improved balloon materials have led to reported immediate procedural success rates of 82% (in one cohort of 103 patients) for reducing trans-coarct pressure gradients to an average of 10 mm Hg.
In another study of 71 patients followed for 11 years undergoing balloon angioplasty for recoarctation after prior surgery, immediate success was achieved in 71%, and persisted in 69% of patients during long-term follow up. In that study the main determinant of immediate success was older age (range: 1 mo Ð20 yrs). Extravasations, observed in one- quarter of the angiograms, did not progress to aneurysms
Ballooning coarctations:
In another cohort of 69 children followed-up for 8 years, freedom from reintervention was 90% at one year and 87% at five years. Factors associated with decreased time to re-intervention included higher gradient before dilation, smaller percentage change in gradient after dilation, small transverse arch and greater stretch, but not recoil.
For some authorities, current practice is to favor surgical repair in neonates and infants and transcatheter balloon dilation in older children and adults.
1. Saba, S.E., et al., Balloon coarctation angioplasty: follow-up of 103 patients. J Invasive Cardiol, 2000. 12(8): p. 402-6.
2. Mann, C., et al., Balloon dilation for aortic recoarctation: morphology at the site of dilation and long-term efficacy. Cardiol Young, 2001. 11(1): p. 30-5.
3. Ovaert, C., et al., Balloon angioplasty of native coarctation: clinical outcomes and predictors of success. J Am Coll Cardiol, 2000. 35(4): p. 988-96.
4. McCrindle, B.W., Coarctation of the aorta. Curr Opin Cardiol, 1999. 14(5): p. 448-52. 5. Rothman, A., Interventional therapy for coarctation of the aorta. Curr Opin Cardiol, 1998. 13(1): p. 66-72.
Image
Suprasternal notch view of the aortic arch shows the discrete narrowing in the descending limb just a centimeter or so distal to the take-off of the left subclavian artery.
Color doppler suprasternal notch view of the aortic arch shows the turbulence and higher velocities at the discrete narrowing in the descending limb just a centimeter or so distal to the take-off of the left subclavian artery.
Short axis view of the aortic valve shows the bicuspid configuration often associated with coarctation (and an incidental membraneous septal aneurysm).