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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 715-719, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
B Brandt 3d, WJ Marvin Jr, EF Rose and LT Mahoney
This study was designed to assess the long-term effects of balloon
angioplasty for coarctation of the aorta. Eleven asymptomatic children,
aged 4 to 6 years, underwent balloon angioplasty. Mean peak gradient fell
from 50.5 +/- 4.7 mm Hg before angioplasty to 21.7 +/- 3.1 immediately
after angioplasty. Children were then followed up at 3 to 6 month intervals
and were recatherized 5 to 14 months after balloon angioplasty. On the
basis of these catheterization findings, patients were divided into three
groups: group I--four patients, residual gradient less than 10 mm Hg and no
anatomic abnormalities; Group II-- three patients, increase of gradient to
greater than 25 mm Hg, mean 34 mm Hg; Group III--four patients, aneurysmal
dilatation in the area of the balloon angioplasty. The seven patients in
groups II and III underwent elective resection of their coarctation at 7 to
28 months after balloon angioplasty with end-to-end anastomosis.
Somatosensory evoked potentials were monitored during the operation. There
were no operative deaths and no gradients between arm and leg pressures
postoperatively. One patient had mild paresis of the lower extremities.
Pathologic examination of the specimens revealed an absence of muscle and
elastic lamella in the area of the aneurysms. This finding was present in
all specimens regardless of whether there was aneurysmal dilatation.
Neofibroelastic proliferation at the site of the tear was responsible for
persistent gradients. Balloon angioplasty may result in aneurysmal
formation and/or recurrent stenosis in the area of the tear necessitating
elective surgical repair. Surgical treatment is the same as for native
coarctation when done early after balloon angioplasty, but may be
associated with increased risk because of the lack of collateral
circulation. Continued follow-up of these lesions is necessary.
ARTICLES
Surgical treatment of coarctation of the aorta after balloon angioplasty
Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242.
This article has been cited by other articles:
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  S. Kutty, R. K. Greenberg, S. Fletcher, L. G. Svensson, and L. A. Latson Endovascular Stent Grafts for Large Thoracic Aneurysms After Coarctation Repair Ann. Thorac. Surg., April 1, 2008; 85(4): 1332 - 1338. [Abstract] [Full Text] [PDF]
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 C. G. Cowley, G. S. Orsmond, P. Feola, L. McQuillan, and R. E. Shaddy Long-Term, Randomized Comparison of Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Childhood Circulation, June 28, 2005; 111(25): 3453 - 3456. [Abstract] [Full Text] [PDF]
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 M. E. Fawzy, M. Awad, W. Hassan, Y. Al Kadhi, M. Shoukri, and F. Fadley Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1062 - 1067. [Abstract] [Full Text] [PDF]
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 J. L GIBBS Treatment options for coarctation of the aorta Heart, July 1, 2000; 84(1): 11 - 13. [Full Text]
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D. B. McElhinney, V. M. Reddy, P. Moore, M. M. Brook, and F. L. Hanley Surgical intervention for complications of transcatheter dilation procedures in congenital heart disease Ann. Thorac. Surg., March 1, 2000; 69(3): 858 - 864. [Abstract] [Full Text] [PDF]
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