In cases in which patients show significant localized stenosis as a result of Kawasaki disease, PTCA should be attempted within 6 to 8 years of the onset of the disease. Additionally, intravascular ultrasound imaging was found to be a useful tool for evaluating internal morphology before and after PTCA. In older patients with coronary calcification, other alternatives to PTCA, such as the use of a rotablator or an atherectomy catheter, should be considered.

No abstract

The results show that enteric protein loss begins before the appearance of hypoproteinemia in patients after a modified Fontan operation, and that the measurement of fecal alpha1-antitrypsin concentrations in random stool samples is useful as an early indicator. To watch for the development of PLE after Fontan operation, it may be important to perform longitudinal follow-up examinations of enteric protein loss by measuring fecal alpha1-antitrypsin concentrations early in the postoperative period.

The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.

Ino T, Ohkubo M. Dilation mechanism, causes of restenosis and stenting in balloon coarctation angioplasty. Acta Pzdiatr 1997; 86: 367-71. Stockholm. ISSN 0803-5253 This review focuses on the individual dilation mechanism, the possible cause of restenosis after balloon angioplasty and the clinical application of a stent in coarctation of the aorta. Balloon angioplasty is still not the first choice of therapy in neonates with native coarctation because of the potential risk of aortic disruption, the high incidence of restenosis and the satisfactory results of surgical coarctectomy. Intravascular ultrasound imaging provides the individual mechanism of aortic dilation by balloon, and this will be a new modality for assessing the relationship between restenosis and aortic luminal morphology after balloon dilation. Although the cause of restenosis after balloon angioplasty remains uncertain, it may be due to a combination of elastic recoil by ductal tissue constriction, intimal hyperplasia and arterial remodelling. A stent could be an effective alternative to conventional balloon angioplasty in native coarctation of the aorta, preventing ductal tissue constriction. However, the problematic relationship between patient growth and relative stenosis of the stent should be clarified before clinical application of a stent for this disease. 0 Balloon angioplasty, coarctation of the aorta, intravascular ultrasound imaging, restenosis, stent

No abstract

The first cause of restenosis is obstructive neointimal formation caused by the proliferation of undifferentiated SMC into the subendothelial tissue. This proliferation seems to be triggered by BA. The distribution of SM2 1 month after balloon angioplasty showed a similar pattern of proliferation of SMC in the external layer around the DA. This may represent a second mechanism of restenosis.

The effects of stretch and immediate recoil after balloon angioplasty were evaluated in 21 patients with coarctation of the aorta who underwent balloon coarctation angioplasty. A total of 28 procedures were performed in these patients, who ranged in age from 1 month to 17 years with a mean of 4.3 years. The systolic pressure gradient and coarcted diameter changed significantly from 42 +/- 22 to 14 +/- 9 mmHg (P < 0.0001) and from 4.0 +/- 1.7 to 6.1 +/- 2.0 mm (P < 0.001), respectively. Immediate recoil was responsible for the loss of 33% of the potentially achievable coarcted dimension. Recoil was determined mainly by the degree of arterial stretch. Gain increased exponentially with an increase in stretch. There was a narrow range of % stretch (60-80%) within which an effective diameter gain could be obtained. Both gain and stretch were the best predictors for late restenosis: patients with a larger immediate gain and stretch developed more restenosis. These results suggest that the stretch-recoil-gain relationship may be clinically important for evaluating the best predictor of late restenosis after balloon coarctation angioplasty.