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 angiop lasty for aortic recoarctation with respect to the type of initial ope ration and to determine the midterm effect on systolic blood pressure. Design-Prospective study of invasive haemodynamic and angiographic da ta and non-invasive data on upper body blood pressure. Setting-Tertiar y referral centre for paediatric cardiology. Subjects-24 infants and c hildren (age 0.3-16.2 years, mean 5.9 years) who had had surgical corr ection for coarctation (end to end anastomosis (14 patients) subclavia n flap angioplasty (nine), patch angioplasty (one)). Main outcome meas ures-Peak systolic gradient over the recoarctation and aortic diameter s before and directly after angioplasty and at follow up. Upper body b lood pressure before and after angioplasty and at latest follow up. Re sults-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 fur ther decrease in the residual gradient at follow up (p < 0.05). The co arctation 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 fo llow up after 1.4 (0.5) years without significant changes in other aor tic diameters. Upper body systolic blood pressure decreased from 138 ( 24) to 115 (17) mm Hg after balloon angioplasty, and the effect on blo od pressure persisted at a mean follow up of 3.7 years. One patient di ed of ventricular failure. Femoral artery thrombosis occurred in three patients. In one patient a small aneurysm occurred that had not incre ased at follow up. In one patient restenosis after angioplasty was red ilated successfully. In one patient dilatation of a residual stenosis after angioplasty failed. Conclusion-Balloon angioplasty for recoarcta tion is effective and is associated with accelerated growth of the dil ated segment at follow up in many patients. The complication rate is a cceptable. Midterm follow up shows persistent relief of upper body hyp ertension in most patients.