Balloon angioplasty of postsurgical recoarctation in infants - The risk ofrestenosis and long-term follow-up

OBJECTIVES This study was undertaken to evaluate the long-term results of b alloon angioplasty (BA) for postsurgical recoarctation in infants. BACKGROUND Balloon angioplasty is a well-accepted modality for the treatmen t of recoarctation. However, infants remain a group of concern because of t heir size, risk for complications and the potential for restenosis with gro wth. Age <12 months has been determined to be a risk factor for the develop ment of recoarctation after angioplasty for native coarctation. Although st udies on postsurgical coarctation have found no relationship between age at angioplasty and the development of recoarctation, few studies specifically addressing infants have been performed. METHODS Clinical, echocardiographic, hemodynamic and angiographic data on 2 2 consecutive children <1 year of age who underwent BA between 1986 and 199 6 were reviewed. RESULTS A successful result, defined as a postprocedure gr adient of less than or equal to 20 mm Hg, was achieved in 20 of 22 (91%) in fants with a reduction in the systolic peak pressure gradient from 48 +/- 2 7 to 9 +/- 10 mm Hg (p < 0.001) and an increase in coarctation diameter fro m 2.7 +/- 1.1 to 5.2 +/- 1.5 mm (p < 0.001). At long-term follow-up of a me dian of 56 months (0.6 to 12 years), the restenosis rate after an initial o ptimal result was 16% (3 of 19). Five (24%) infants required reintervention (2 initially unsuccessful; 3 recoarctation), with a success rate of 95% af ter two procedures. Suboptimal long-term outcome correlated with a lower in fant weight. CONCLUSION Balloon angioplasty can be safely performed in infants, with goo d long-term results. The risk of restenosis is low and can be successfully managed with repeat angioplasty. (C) 1999 by the American College of Cardio logy.