BALLOON ANGIOPLASTY OF RECURRENT COARCTATION - A 12-YEAR REVIEW

Objectives. This study was undertaken to investigate the longterm outc ome of balloon angioplasty for recurrent coarctation of the aorta in a large series of patients. Background. Balloon angioplasty has become the standard treatment for residual or recurrent aortic coarctation. D espite the widespread use of this treatment modality, there are few da ta outlining the long-term outcome of a large patient cohort. Methods. Clinical, echocardiographic, hemodynamic and angiographic data on 90 consecutive patients who underwent balloon angioplasty between January 1984 and January 1996 were reviewed. Results. Mean systolic pressure gradients were reduced from 31 +/- 21 to 8 +/- 9 mm Hg after dilation (p = 0.0001). The mean diameter of the stenotic site, measured in the frontal and lateral views, increased by 38% and 35%, respectively (p = 0.001). Neurologic events occurred in two patients, with one death. A n aortic tear occurred in one patient, requiring surgical intervention . Optimal results mere defined as a postprocedure gradient <20 mm Hg a nd were obtained acutely in 88% of patients. At long-term follow-up (1 2 years), 53 (72%) of 74 patients with an early optimal result remaine d free from reintervention. Transverse arch hypoplasia, defined as an arch dimension <2 SD below the mean for age, was the primary predictor of the need for reintervention. Conclusions. Although the majority of patients undergoing percutaneous balloon angioplasty for recoarctatio n of the aorta will achieve long-term benefit, the need for further su rgical intervention in those,vith transverse arch hypoplasia remains h igh. (C) 1997 by the American College of Cardiology.