PERCUTANEOUS BALLOON ANGIOPLASTY FOR NATIVE COARCTATION OF THE AORTA

[摘要] Twenty-six children, aged 5 weeks to 14.7 years, underwent percutaneous balloon angioplasty for a discrete native coarctation of the aorta. The procedure reduced the systolic coarctation gradient acutely in all children. The mean systolic gradient decreased by 75%, from 48.6 .+-. 2.4 before to 12.3 .+-. 1.9 mm Hg after angioplasty (p < 0.001). Long-term results were evaluated in 14 children by follow-up catheterization 12 to 26 months (mean 15.3) after angioplasty. At follow-up, the residual gradient average 11.7 .+-. 3.7 mm Hg (range -5 to 36) and had not changed from that measured immediately after angioplasty (p = 0.64). Compared with preangioplasty values, the systolic pressure in the ascending aorta had improved substantially at follow-up (116.0 .+-. 3.2 versus 143.9 .+-. 3.1 mm Hg, p < 0.001). On the basis of follow-up data, two groups of children were identified: Group 1 consisted of nine children with a good result, defined as a residual gradient < 20 mm Hg and no aneurysm; Group 2 consisted of five children with a poor result, four with a residual gradient > 20 mm Hg (range 25 to 36) and one with an aneurysm at the dilation site. There was no statistical difference between the two groups in age at angioplasty, balloon size, ratio of balloon to isthmus diameters, follow-up duration, heart rate or cardiac output. However, of the four children with a residual gradient > 20 mm Hg, two were the youngest in the study, and in two the aorta was inadvertently dilated with a balloon 4 to 5 mm smaller than the isthmus diameter. There was a significant difference between groups in the systolic coarctation gradient before angioplasty. All children whose preangioplasty gradient was < 50 mm Hg had a good outcome, while five of six children whose preangioplasty gradient was .gtoreq. 50 mm Hg had a poor long-term result (Fisher exact test, p = 0.003). Thus, a good long-term result was documented in 64% of patients and appears most likely to be achieved in children with a preangioplasty gradient < 50 mm Hg. Percutaneous balloon angioplasty may provide an effective nonsurgical approach to some children with a native coarctation.

[发布日期] 1987-11-01