M. Chessa et al., Balloon angioplasty in infants with aortic obstruction after the modified stage I Norwood procedure, AM HEART J, 140(2), 2000, pp. 227-231
Citations number
26
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background The incidence of coarctation after stage I Norwood procedure var
ies between 11% and 37%, and it contributes to late death after this operat
ion. We describe the incidence and report the results of percutaneous ballo
on angioplasty of neoaortic arch obstruction in patients after the modified
Norwood procedure for hypoplastic left heart syndrome (HLHS).
Methods During a period of 5 years, 136 patients (94 male, 42 female) under
went a first stage modified Norwood procedure for HLHS. All 95 survivors (6
9.8%) underwent cardiac catheterization before the second stage. Neoaortic
arch obstruction was diagnosed on documentation of a peak systolic gradient
of >10 mm Hg across the arch associated with angiographic evidence of loca
lized narrowing of the aortic lumen.
Results Twenty-one (22.1.%) of the 95 survivors were documented to have neo
aortic arch obstruction. Seventeen patients underwent percutaneous balloon
angioplasty for the relief of the neoaortic arch obstruction. The predilata
tion peak gradient across the arch was reduced significantly by angioplasty
from 28.6 +/- 16.9 mm Hg (range 10 to 73 mm Hg) to 5.3 +/- 5.2 mm Hg (rang
e 0 to 19 mm Hg) (P <.001). A final gradient <10 mm Hg or <70% of the start
ing gradient was considered a success.
Conclusion The absence of serious sequelae after the procedure or need for
reintervention, as shown by our study, makes balloon angioplasty an effecti
ve technique and the treatment of choice for the relief of recoarctation of
the neoaortic arch in patients with staged palliation of HLHS.