Long-term follow-up of percutaneous balloon angioplasty in adult aortic coarctation

Purpose: To assess long-term outcomes following percutaneous transluminal a ngioplasty (PTA) of congenital aortic coarctation in adults. Methods: Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 y ears), were reviewed at a mean interval after angioplasty of 7.3 years (ran ge 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Dop pler echocardiography, and clinical examination. Current clinical measureme nts were compared with pre- and immediate post-angioplasty measurements. Results: At follow-up 16 patients were alive and well. The patient not incl uded in follow-up had undergone surgical repair and excision of the coarcta tion segment following PTA. Mean brachial systolic blood pressure for the g roup decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p = 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at follow-up (p = 0.001). The average number of antihypertensive drugs requir ed per patient decreased from 0.56 to 0.31 (p = 0.234). No significant resi dual stenoses or restenoses were seen at MRI. Small but clinically insignif icant residual pressure gradients were recorded in all patients using Doppl er echocardiography. Complications included one transient ischemic attack a t 5 days, one external iliac dissection requiring stent insertion, and a fu rther patient who developed a false aneurysm close to the coarctation site at 12 months which subsequently required surgical excision. Conclusion: PTA of adult coarctation is safe and effective in the long term . Although primary stenting has recently been advocated in the treatment of this condition, our results suggest that PTA remains the treatment of choi ce.