EFFECT OF INTRODUCING BALLOON DILATION OF NATIVE AORTIC COARCTATION ON OVERALL OUTCOME IN INFANTS AND CHILDREN

The outcome of 40 consecutive newborns and children with normal cardia c connections presenting with unoperated (i.e., no previous surgical o r balloon dilation treatment) aortic coarctation since the introductio n of balloon dilation as a treatment option (group A) was compared ret rospectively with that of a similar cohort of 38 patients (group B) pr esenting in the period immediately before the introduction of balloon dilation. Group A consisted of 18 newborns (<30 days) and 22 children and Group B consisted of 20 newborns and 18 children. In group A, 30 p atients had balloon dilation but 10 underwent surgery because of paren tal preference, unfavorable anatomy or for logistic reasons. Group B h ad conventional surgical repair by various methods. All patients were followed up clinically by Doppler echocardiography and, when possible, by magnetic resonance imaging. Repeat cardiac catheterization was onl y performed in those with suspected recoarctation. Survival and freedo m from reintervention were investigated using Kaplan-Meier analysis. P atients of all ages in group A and those who had balloon dilation were at higher risk for reintervention (25 and 30%, respectively, at 1 yea r) than those in group B or those who had surgery (20 and 18%, respect ively, at 1 year). Mortality was not significantly different between g roups A and B, but there were 2 neonatal deaths directly attributable to the dilation procedure. Two patients developed aneurysms after dila tion. Balloon dilation is an effective treatment for unoperated coarct ation, but the recoarctation rate appears to be higher than for surger y.