Percutaneous transluminal angioplasty of congenital coarctation of the aorta

Sperling, Donald R.; Dorsey, Thomas J.; Rowen, Marshall; Gazzaniga, Alan B.

doi:10.1016/s0002-9149(83)80097-6

Cited by 93 publications

(24 citation statements)

References 8 publications

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“…Gruntzig's technique of balloon angioplasty [34] was adopted by Sos [35], Singer [36] and Sperling [37] and their associates to enlarge coarcted aortic segments in a postmortem specimen, post-surgical recoarctation and native coarctation respectively. This is followed by a report of successful use of this technique in a sizeable population of patients with native aortic coarctation by Lababidi [38].…”

Section: Balloon Angioplastymentioning

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: Balloon Angioplastymentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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“…However, after adapting Gruntzig's angioplasty technique [65] to aortic coarctation [66][67][68], it has been used to treat aortic coarctation [69,70]. Despite initial controversy, reviewed elsewhere [71,72], balloon angioplasty was in time adopted [71][72][73] as the treatment of choice for both native and post-operative coarctation in children, adolescents and adults.…”

Section: Coarctation Of the Aortamentioning

confidence: 99%

Transcatheter Stent Therapy in Children: An Update

Sahu

Rao²

2012

Pediat Therapeut

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To address elastic recoil of vessel wall and intimal dissection that can follow balloon angioplasty, stents have been designed and these appear to produce more effective relief of obstruction. Of the two types of stents, namely, balloon expandable and self expandable, balloon expandable stents are most commonly used in children. The usefulness of stents in the management of vascular obstructive lesions not amenable to balloon angioplasty is well established and has been successfully used to treat branch pulmonary artery stenosis, coarctation of the aorta, stenotic right ventricular outflow tract conduits, obstructive lesions of the systemic and pulmonary veins and others. The techniques of implantation, indications, immediate and follow-up results and complications were reviewed. The stents have also been effectively used in keeping open naturally occurring or artificially created inter-circulatory connections and as adjuncts in hybrid procedures, but these have not been discussed in this review. Future directions include investigative work on biodegradable stents and growth stents to address issues related to increase in vessel size in infants and children, use of drug eluding stents to prevent neo-intimal proliferation to avoid pulmonary vein restenosis and refinement of stent technology in hybrid procedures such as neonatal palliation of hypoplastic left heart syndrome and transcatheter completion of Fontan procedure. The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.

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“…Balloon dilatation of postoperative recoarctation has been recommended as the treatment of ~h o i c e ,~~,~~ despite the fact that the reported experience with balloon angioplasty of postoperative aortic recoarctations is limited, 24,[32][33][34][35] especially when compared with that of native coarctations. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] We have r e c~m m e n d e d~~~~~~~~~ balloon angioplasty as the therapeutic procedure of choice for relief of severe, previously unoperated coarctation of the aorta in the neonate and young infant, while only a few other workers1s recommended balloon angioplasty for native coarctations. More recently, Peny et aL3* suggested use of angioplasty for patients with native coarctations who are high surgical risk candidates.…”

Section: Rubio and Limon Lasonl Described A Technique Of Dilatation Omentioning

confidence: 99%

“…None of these patients with aneurysm required therapy nor did any aneurysms rupture, although elective resection and repair was advocated by some workem60 We restudied 20 children 6-30 months following dilatation of native coarctations and 4 children, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] months following dilatation of recoarctation and none devela* aneurysms.39 The reason for this difference is not clear. We postulated use of large balloons, inadvertent manipulation of cathetetdguidewires in the region of freshly dilated aortic coarctation, and misinterpretation or overinterpretation of aneurysm as possible causes.31 The observations of h e r et a2.…”

Section: Complicationsmentioning

confidence: 99%

Balloon angioplasty of aortic coarctation: A review

Rao

1989

Clinical Cardiology

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Summary: Since the initial report of balloon coarctation angioplasty in 1982, several workers used this technique in native coarctation and postoperative recoarctation. Immediate and intermediate-term follow-up nxdts are generally good with a small chance for recoarctation and aneurysmal formation at the site of coarctation. The causes of recoarctation were identified and include age less than 1 year, isthmus hypoplasia, and a small coarcted aortic segment. Despite good immediate and follow-up results, recommendations for use of balloon angioplasty as a treatment procedure of choice are clouded by the reports of development of aneurysms at the site of coarctation. We feel that balloon coarctation angioplasty is the treatment of choice in neonates and small infants, while general use of this technique in both native and postoperative coarctations in older children should await follow-up results in larger numbers of children at selected centers.

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Percutaneous transluminal angioplasty of congenital coarctation of the aorta

Cited by 93 publications

References 8 publications

Coarctation of Aorta-Management Options and Decision Making

Coarctation of Aorta-Management Options and Decision Making

Transcatheter Stent Therapy in Children: An Update

Balloon angioplasty of aortic coarctation: A review

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