PERCUTANEOUS ANGIOPLASTY FOR RECURRENT CO ARCTATION OF THE AORTA IN THE 1ST YEAR OF LIFE

It is not rare for surgery of coarctation of the aorta to be complicat ed by recurrence of the lesion at medium-term, especially when it is p erformed very early in life. Advances in interventional catheterisatio n now offer an alternative to surgical reoperation. This study is a re trospective analysis of balloon angioplasty in 20 patients in whom ist hmic stenosis had been operated before the age of one month in 19 case s, in whom recurrent coarctation was identified 3.2 +/- 2.1 months lat er. The percutaneous angioplasty was performed by a femoral arterial a pproach at an average age of 5.4 +/- 2.3 months. The femoral pulses re turned together with a fall in the transisthmic systolic pressure grad ient from 58.3 +/- 23.4 mmHg to 18.3 +/- 12.5 mmHg, and the isthmic lu men increased by +117 +/- 52%. Judged by the residual pressure gradien t, the results were good, the best results being observed in the short est and most severe stenoses. After a maximum follow-up of 5 years (av erage: 20.1 +/- 16.6 months), the angioplasty was successful in 14 cas es (70%), 4 cases had a mild residual gradient (20%) and 2 were failur e (10%). None of the patients required reoperation. There were no fata lities or early aneurysmal complications in the dilated zone monitored by echocardiography and magnetic resonance imaging. The only complica tion was femoral artery obstruction (6 cases) which was successfully t hrombolysed in 5 cases but which recurred at long-term in 3 cases. The authors conclude that before the age of one, percutaneous angioplasty for recurrent coarctation of the aorta is a simple, safe and generall y effective procedure at medium-term at the price of a relatively low incidence of local complications which should decrease with technical development. The authors consider it to be the treatment of choice of recurrent coarctation even in small babies as the results seem to be b etter than those of surgery.