Percutaneous balloon angioplasty of coarctation of the aorta in children: 12-year follow-up results

Objective To evaluate the efficiency of percutaneous balloon angioplasty of coarctation of the aorta in children and discuss its risk factors that can lead to poor long-term results. Methods From September 1987 to August 1999, 24 patients underwent 27 balloo n angioplasty procedures for native or recurrent coarctation of the aorta a t our institution. There were 19 patients with discrete (membranous) coarct ation, 4 patients with long-segment and aortic arch hypoplasia, and 1 patie nt with postoperative recurrence. The balloon diameter was chosen not to ex ceed the diameter of the aorta proximal to the stenotic site (11.06 +/- 2.8 0 mm vs 11.78 +/- 3.18 mm), with the chosen diameter two to four times that of the stenotic segment (2.57 +/- 0.68 times). The patients have been foll owed up for half to twelve years (mean 6.2 +/- 2.8 years). Satisfactory res ult was defined as a reduction in the pressure gradient across the site of coarctation to less than or equal to 20 mm Hg. Results The systolic pressure gradient across the coarctation site decrease d from 48.17 +/- 14.68 mm Hg to 14.96 +/- 13.12 mm Hg ( P < 0.01) and the d iameter of the coarctation site increased from 4.66 <plus/minus> 2.43 mm to 8.80 +/- 3.32 mm ( P < 0.01). Immediate satisfactory results were obtained in 19 patients (79%). Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patient s with satisfactory results, 18 patients had membranous coarctation and 1 p atient had recurrent postoperative coarctation. No aneurysm and other compl ications had occurred in any patients at the follow-ups. Conclusion Percutaneous balloon angioplasty is an effective treatment alter native to surgery in most patients with recurrent postoperative or native m embranous coarctation of the aorta. It should not be recommended for the co arctation of aortic arch hypoplasia.