Balloon angioplasty for aortic recoarctation in children: initial and follow up results and midterm effect on blood pressure.

OBJECTIVE: To assess the direct and follow up results of balloon angioplasty for aortic recoarctation with respect to the type of initial operation and to determine the midterm effect on systolic blood pressure.
DESIGN: Prospective study of invasive haemodynamic and angiographic data and non-invasive data on upper body blood pressure.
SETTING: Tertiary referral centre for paediatric cardiology.
SUBJECTS: 24 infants and children (age 0.3-16.2 years, mean 5.9 years) who had had surgical correction for coarctation (end to end anastomosis (14 patients) subclavian flap angioplasty (nine), patch angioplasty (one)). MAIN OUTCOME MEASURES: Peak systolic gradient over the recoarctation and aortic diameters before and directly after angioplasty and at follow up. Upper body blood pressure before and after angioplasty and at latest follow up.
RESULTS: Mean peak systolic gradient initially decreased from 35 (15) to 12 (9) mm Hg (p < 0.001) and was 9 (10) mm Hg at follow up after 1.4 (0.5) years. Patients with a subclavian flap repair showed a slight further decrease in the residual gradient at follow up (p < 0.05). The coarctation diameter increased from 5.3 (2.6) to 7.7 (2.5) mm (p < 0.001), and a further increase to 9.3 (2.9) mm (p < 0.01) was present at follow up after 1.4 (0.5) years without significant changes in other aortic diameters. Upper body systolic blood pressure decreased from 138 (24) to 115 (17) mm Hg after balloon angioplasty, and the effect on blood pressure persisted at a mean follow up of 3.7 years. One patient died of ventricular failure. Femoral artery thrombosis occurred in three patients. In one patient a small aneurysm occurred that had not increased at follow up. In one patient restenosis after angioplasty was redilated successfully. In one patient dilatation of a residual stenosis after angioplasty failed.
CONCLUSION: Balloon angioplasty for recoarctation is effective and is associated with accelerated growth of the dilated segment at follow up in many patients. The complication rate is acceptable. Midterm follow up shows persistent relief of upper body hypertension in most patients.