Treatment of restenosis of coarctation by percutaneous transluminal angioplasty.

Kan, Jean S.; White, Robert I.; Mitchell, Sally E.; Farmlett, E J; Donahoo, James S.; Gardner, Timothy J.

doi:10.1161/01.cir.68.5.1087

Cited by 164 publications

(33 citation statements)

References 24 publications

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“…Follow-up angiography 15 Discussion The long-term follow-up of patients after surgery for coarctation of the aorta has demonstrated a significant incidence of recurrent or residual coarctation, especially in patients operated on when less than 1 year old.1-8 This is reconfirmed in the present study with a median age of 13 days at the time of surgery in the group of patients who developed recurrent or residual obstruction. At the initial angioplasty procedure, 88% of patients (23 of 26) had a good result with a residual peak systolic pressure difference of 20 mm Hg or less regardless of the type of initial surgery.…”

Section: Complicationssupporting

confidence: 75%

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Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results.

et al. 1991

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BACKGROUND As angioplasty techniques have been refined and larger low-profile balloons developed, a nonsurgical approach to recoarctation has become available. Several reports have documented both the efficacy and safety of this procedure. However, there are little data available on the long-term follow-up of these patients. This report details the initial results and long-term evaluation of both the relief of obstruction and the presence of hypertension after balloon angioplasty for recurrent coarctation. METHODS AND RESULTS Balloon angioplasty for recurrent coarctation of the aorta was performed 29 times in 26 patients at a median age of 4 years and 9 months (range, 4 months to 29 years), with eight patients less than 1 year old. Initial surgical techniques were end-to-end anastomosis in 11 patients, subclavian flap aortoplasty in 11 patients, and patch aortoplasty in four patients. Angioplasty was performed at a median interval of 2 years and 7 months (range, 4 months to 23 years) after surgery. Mean peak systolic pressure difference across the coarctation decreased from 40.0 +/- 16.8 to 10.3 +/- 9.5 mm Hg (p less than 0.05) after the initial angioplasty, and mean diameter of the aortic lumen at the coarctation site increased from 5.8 +/- 3.5 to 9.0 +/- 4.3 mm (p less than 0.05). There was no mortality, and only one patient developed an aneurysm (4%). Three patients underwent repeat angioplasty for a pressure difference of more than 20 mm Hg. Long-term follow-up is available on 24 of 26 patients with a mean follow-up of 42 +/- 24 months (range, 12-88 months). Mean peak systolic pressure difference across the area of coarctation decreased from 40.3 +/- 17.4 before angioplasty to 8.5 +/- 8.3 mm Hg after final angioplasty (p less than 0.05) and 7.5 +/- 7.5 mm Hg at follow-up. Mean peak systolic blood pressure in the upper extremities decreased from 133.1 +/- 14.9 before angioplasty to 111.1 +/- 14.1 mm Hg at long-term follow-up (p less than 0.05). CONCLUSIONS Balloon angioplasty should be considered the treatment of choice for relief of recurrent aortic coarctation.

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Section: Complicationssupporting

confidence: 75%

“…However, there are little data available on the long-term follow-up of these patients. [10][11][12][13][14][15][16][17][18][19] This report details the initial results and long-term evaluation of both the relief of obstruction and the presence of hypertension after balloon angioplasty for recurrent coarctation.…”

mentioning

confidence: 98%

Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results.

et al. 1991

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“…The conditions that have been treated with this technique include: pulmonary valvular,`branch pulmonary artery,7 and pulmonary vein stenosis,j9 aortic valve stenosis,1-5 superior and inferior vena caval obstruction, 16,17 coarctation of the aorta,1-24 and restenosis coarctation. 25 The current report presents our initial and long-term results with seven patients with discrete coarctation.…”

mentioning

confidence: 94%

Angioplasty for coarctation of the aorta: long-term results.

Cooper¹,

Ritter²,

Rothe³

et al. 1987

Circulation

122

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Balloon coarctation angioplasty (BCA) was performed in seven consecutive patients (five boys and two girls) 18 months to 18 years old (mean 9.5) with isolated discrete unoperated coarctation of the aorta. A No. 8F or 9F catheter was chosen with balloon lengths of 30 or 40 mm and maximum inflation diameters 1 mm less than the smallest measured aortic diameter determined 1 cm proximal to the coarctation site. A 10 sec inflation-deflation cycle of 6 to 8 atmospheres (90 to 120 psi) was perforined. coarctation.25 The current report presents our initial and long-term results with seven patients with discrete coarctation. MethodsSeven patients (five boys, two girls) 18 months to 18 years old (mean 9.5) underwent percutaneous balloon dilatation angioplasty for unoperated discrete coarctation of the aorta from December 1983 to December 1984. All patients had clinical evidence of coarctation as manifested by diminished femoral long-term safety and efficacy.pulses, systolic hypertension of the upper extremities, and short grade 2/6 systolic ejection murmur at the left base and back. A chest x-ray, electrocardiogram, two-dimensional, and pulsed Doppler echocardiogram were obtained for each patient. Magnetic resonance images of the thoracic aorta were obtained in all patients after the angioplasty. Two patients underwent magnetic resonance imaging before angioplasty. Informed written consent was obtained for each patient and patients were enrolled in a research protocol approved by the Research and Clinical Projects Committee (IRB). The specific technique employed for our balloon angioplasty has been previously reported.24Follow-up evaluation consisted of repeat physical examination with arm/leg blood pressure determinations by sphygmomanometer, electrocardiography, and two-dimensional and pulsed Doppler echocardiography both 1 month and 1 year after coarctation angioplasty. Magnetic resonance images were obtained in all patients from 1 to 16.5 months (mean 7.1 months) after angioplasty. Electrocardiographically gated magnetic resonance images were obtained in coronal, sagittal, transaxial, and left anterior oblique imaging planes with a 0.6 tesla superconducting magnet to obtain 0.75 to 1 cm thick sections. Repeat aortograms and intra-aortic pullback pressure gradients were obtained in all seven patients.

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“…The technique was used clinically by Lock and others. 8,16,[165][166][167][168][169] Indications for balloon dilation of coarctation of the aorta are essentially the same as those for surgery: hypertension proximal to the coarctation with a resting systolic pressure gradient across the narrowed segment greater than 20 mm Hg or angiographically severe coarctation with extensive collaterals. The mechanism of relief of coarctation with balloon dilation involves tearing of the intima and often the media of the vessel.…”

Section: Balloon Angioplasty Balloon Dilation Of Coarctation Of the Amentioning

confidence: 99%

Pediatric Therapeutic Cardiac Catheterization

Allen¹,

Beekman²,

Garson³

et al. 1998

Circulation

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Treatment of restenosis of coarctation by percutaneous transluminal angioplasty.

Cited by 164 publications

References 24 publications

Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results.

Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results.

Angioplasty for coarctation of the aorta: long-term results.

Pediatric Therapeutic Cardiac Catheterization

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