QUANTITATIVE ECHOCARDIOGRAPHIC ANALYSIS OF THE AORTIC-ARCH PREDICTS OUTCOME OF BALLOON ANGIOPLASTY OF NATIVE COARCTATION OF THE AORTA

Background The use of balloon angioplasty for treatment of native aort ic coarctation is controversial. Cineangiographic data suggest that ao rtic arch hypoplasia and isthmic narrowing are associated with angiopl asty failure. This study of echocardiographic measurements of preangio plasty aortic arch morphology was performed to identify potential anat omic predictors of outcome noninvasively. Methods and Results The prea ngioplasty echocardiograms of 105 patients 3 days to 17 years old with native coarctation of the aorta were analyzed off-line. Angioplasty w as considered successful if the residual coarctation gradient was <20 mm Hg and no intervention for recoarctation occurred. Univariate analy sis identified young age at angioplasty, presence of a patent ductus a rteriosus, and the diameters of the aortic isthmus, distal transverse arch, and aortic valve as predictors of early and late outcomes. Multi variate analysis showed that the preangioplasty aortic isthmus z value was the best independent predictor of outcome, eliminating the effect on outcome of age and associated cardiac defects. An isthmus z value less than or equal to-2.16 predicted early failure with 91% sensitivit y and 85% specificity. Kaplan-Meier analysis demonstrated that 90% of patients with an isthmus z value >-1.0 remained free of recoarctation at late followup, whereas 89% of patients with a preangioplasty isthmu s z value less than or equal to-2.0 developed recoarctation within 36 months. Conclusions Echocardiographic measurements of the aortic arch predict both early and late outcomes of balloon angioplasty for native aortic coarctation, and the preangioplasty aortic isthmus z value was the best independent predictor. Quantitative aortic tic arch analysis may improve selection of angioplasty candidates who are likely to ben efit from the procedure.