LONG-TERM FOLLOW-UP RESULTS OF BALLOON ANGIOPLASTY OF POSTOPERATIVE AORTIC RECOARCTATION

Immediate- and short-term follow-up results of balloon dilatation of a ortic recoarctation following surgery have been well documented, but t here is sparse data on long-term follow-up. During a 10-year period en ding in August 1995, 33 children, aged 2 months to 14 years old, under went balloon angioplasty of aortic recoarctation. Prior surgery includ ed resection and end-to-end anastomosis (n = 9), subclavian flap (n = 16) or prosthetic (Dacron or Gore-Tex) patch (n = 5) angioplasty, and repair of an interrupted aortic arch (n = 3). Recoarctation developed 1 month to 14 years (mean +/- SD 29 +/- 44 months) after surgery. The indications for angioplasty were peak-to-peak systolic gradients >20 m m Hg and systemic hypertension and/or congestive heart failure. After balloon angioplasty, the peak-to-peak systolic pressure gradient acros s the coarctation decreased from 48 +/- 22 to 13 +/- 15 mm Hg (p <0.01 ), and the size of the coarcted segment increased from 3.3 +/- 1.4 to 6.5 +/- 2.3 mm (p <0.01). Follow-up angiography and/or magnetic resona nce imaging were performed in 20 children 17 +/- 12 months after angio plasty. No aneurysms were observed and improvement in the diameter of the coarcted aortic segment (9 +/- 3 mm) persisted. One- to 10-year (m edian 5) clinical follow-vp was available in 32 children. During follo w-up, 2 children required surgery to repair a long tubular isthmic nar rowing. The residual gradients, determined by arm-leg systolic blood p ressure difference, were 5 +/- 8 mm Hg. No patient was symptomatic and only 1 patient (3%) was hypertensive, controlled with antihypertensiv e medications. We conclude that balloon angioplasty of aortic recoarct ation following all types of surgical repair is feasible, safe, and ef fective with good long-term results. We recommend balloon angioplasty as the procedure of choice in the management of postsurgical recoarcta tion with hypertension and/or congestive heart failure. (C) 1998 by Ex cerpta Medica, Inc.