Long-Term Follow-Up Results of Balloon Angioplasty of Postoperative Aortic Recoarctation

Siblini, Ghassan; Rao, P. Syamasundar; Nouri, Soraya; Ferdman, Barbara; Jureidini, Saadeh B.; Wilson, Allen D.

doi:10.1016/s0002-9149(97)00805-9

Cited by 66 publications

(63 citation statements)

References 30 publications

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“…Although we have not discussed the management of postsurgical recoarctations [94] in this review, there is general agreement that balloon angioplasty is the treatment of choice for treatment of these aortic recoarctations …”

Section: Therapy Selectionmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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Coarctation of the Aorta (CoA) is a congenital cardiac anomaly consisting of a constricted aortic segment with a prevalence of 5 to 8% of all Congenital Heart Defects (CHD). The classic CoA is located in the thoracic aorta distal to the origin of the left subclavian artery, at about the level of the ductal structure. Significant hypertension and/or congestive heart failure are indications of intervention. If hypertension (rather that heart failure) is the clinical problem, it is better to relieve the aortic obstruction promptly rather that attempting to "treat" hypertension with antihypertensive medications. Surgical relief of the aortic obstruction and catheter interventional techniques (balloon angioplasty and stents) are available alternatives. Since the introduction of surgical correction by Crafoord and Nylin and Gross and Hufnagel in early 1940s, surgical therapy has been the treatment of choice for aortic coarctation. Gruntzig's technique of balloon angioplasty was adopted by Singer and Sperling and their associates to enlarge coarcted aortic segments in post-surgical recoarctation and native coarctation, respectively in early 1980s. This is followed by the application of the technique by other cardiologists to treat native CoA. The procedure consists of inserting a balloon angioplasty catheter across the site of coarctation and inflating the balloon with diluted contrast material. Both immediate and followup results are reasonably good. Residual and recurrent obstructions following surgery and prior balloon angioplasty are also amenable for balloon angioplasty. Despite reasonably good short-term and long-term results of balloon angioplasty, some problems remain and include restenosis, probability of aortic rupture, formation of aneurysms and inability to effectively treat long-segment tubular narrowing. Because of these and other reasons, endovascular stenting of aortic coarctation has gained acceptance over the last decade. The balloon catheter, with the stent mounted on it, is advanced over a stiff guide wire and positioned across the coarctation segment and the balloon inflated, thus implanting the stent. Most cardiologists use stents in adolescents and adults and restrict their use in younger children because of issues related to growth. Stent therapy appears to be an attractive method for treatment of native or recurrent coarctation, aneurysm formation following prior surgical or balloon intervention and for long segment hypoplasia. Role of covered stents to manage aortic coarctation is limited and are used when the assessed risk for development of aneurysm or dissection is high. A comparison of all available treatment modalities was made and while it is difficult to make a definitive statement, the overall data seem to indicate that transcatheter methods may be better than surgery. Selection of the method of therapy is largely based on the age at presentation and anatomy of the coarcted segment and surrounding structures; surgery for infants and long segment coarctations, balloon angioplast...

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Section: Therapy Selectionmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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“…Catheter intervention using an inflatable balloon is an effective treatment for native coarctation of the aorta (10) or recurrent coarctation after primary surgical repair (11). However, controversy exists about the clinical outcome of this procedure with regard to the high incidence of aneurysm formation or recoarctation when balloon angioplasty was used as treatment for native coarctation (12).…”

Section: Coarctation Of the Aortamentioning

confidence: 99%

Postoperative evaluation of congenital heart disease by magnetic resonance imaging

Roest

Helbing

Wall

et al. 1999

J. Magn. Reson. Imaging

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“…Immediate results tabulated elsewhere [105,137] and those gathered by VACA Registry [41, 69] seem excellent with relief of pressure gradient and increase in the size of the coarcted segment. The improvement is irrespective of the type of surgical repair [137,167]. Several intermediate-term follow-up results have been published (tabulated elsewhere [105,167]), which show recoarctation and aneurysmal formation in 19% and 7% of followed-up patients, respectively.…”

Section: Postsurgical Aortic Recoarctationmentioning

confidence: 99%

“…The improvement is irrespective of the type of surgical repair [137,167]. Several intermediate-term follow-up results have been published (tabulated elsewhere [105,167]), which show recoarctation and aneurysmal formation in 19% and 7% of followed-up patients, respectively. Need for surgical intervention to relieve isthmic hypoplasia occurred in a few patients.…”

Section: Postsurgical Aortic Recoarctationmentioning

confidence: 99%

Interventional Pediatric Cardiology: State of the Art and Future Directions

Rao

1998

Pediatr Cardiol

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Although the interventional pediatric cardiology began in the early 1950s, it was not until the mid-1980s that a full spectrum of transcatheter interventions in children could be undertaken including balloon atrial septostomy which has been in usage since 1966. Enormous developments have occurred even from the mid-1980s to date. In this review, current state-of-the-art for each broad area of therapeutic catheterization is presented. A large variety of lesions could be opened-up or closed, as the case may be and the results of these interventions were either similar to or better than those reported for the alternative surgical therapy. Indeed, therapeutic catheterization techniques have replaced the conventional surgery for many lesions and are threatening to do so for others. However, long-term follow-up results are scanty and are needed. Further miniaturization of catheters/sheaths used in interventional pediatric cardiology and development of new technology for the lesions which are not amenable to currently available transcatheter methods are awaited. The future seems to be bright for interventional pediatric cardiology.

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Long-Term Follow-Up Results of Balloon Angioplasty of Postoperative Aortic Recoarctation

Cited by 66 publications

References 30 publications

Coarctation of Aorta-Management Options and Decision Making

Coarctation of Aorta-Management Options and Decision Making

Postoperative evaluation of congenital heart disease by magnetic resonance imaging

Interventional Pediatric Cardiology: State of the Art and Future Directions

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