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Objective: Coarctation of the aorta can be treated surgically or with balloon angioplasty. The objective of our study was to describe the results after percutaneous balloon angioplasty with or without stent implantation for coarctation of the aorta and establish the incidence of recovery during follow-up., Method: Cohort study. 89 patients of any age where included in a follow up period of nine years., Results: Of the 89 patients included in the study, 69.0% were male. The mean follow-up for all participants was 33.66 months. 32.5% of the patients had a stent implanted during the angioplasty procedure; of which 24.1% suffered recoarctation during follow-up. In the group without stent implantation, 36.6% suffered recoarctation. There was not significant difference in the survival curves of the two groups (p = 0.899)., Conclusions: Stent implantation during balloon angioplasty to treat aortic coarctation did not influence in the incidence of aortic recoarctation; but factors such as preangioplasty arterial hypertension and the final angioplasty gradient > 20 mmHg is associated with aortic recoarctation., (Copyright: © 2021 Permanyer.)

Echocardiography is the mainstay of preoperative arch imaging in infants with coarctation of the aorta. In simple coarctation, repair by way of sternotomy or thoracotomy is often determined by echocardiographic transverse arch measurements. The degree of arch hypoplasia that is prohibitive to repair by way of thoracotomy is unknown. Clinical predictors of recoarctation are also unknown. Demographic, echocardiographic (transverse arch and aortic measurements), operative, and postoperative data of infants <90 days old with simple coarctation repaired by way of thoracotomy between February 2005 and November 2011 were evaluated. Recoarctation was defined as surgical or catheter reintervention after hospital discharge. Eighty-four infants underwent coarctation repair at median age of 12 (range 1-85) days with median follow-up of 12.3 (range 0.5-71.9) months. The seven (8 %) infants with recoarctation underwent balloon angioplasty. In multivariable analysis, only greater postoperative Doppler peak velocity [1.13, confidence interval (CI) 1.04-1.23] and greater sinotubular junction z-score (hazard ratio 4.19, CI 1.47-11.95) independently predicted coarctation. Doppler peak velocity >2.12 m/s had sensitivity of 63 % and specificity of 83 % of predicting recoarctation, and ST junction z-score >-0.93 had sensitivity of 100 % and specificity of 58 %. No transverse arch dimensions were independently associated with recoarctation. Infants with transverse arch z-score as low as -2.8 underwent successful repair by way of thoracotomy. No clinical predictors were significant.

Background: Persistence or recurrence of stenosis is a complication of coarctation repair and is associated with major long-term morbidity. The rate of recurrence varies significantly, depending on the age of the patient, technique at initial repair, and the arch anatomy. We reviewed our experience with surgical repair of recurrent coarctation of the aorta and compared it with our institutional experience with balloon aortoplasty., Methods: We retrospectively reviewed our experience with 1,012 patients undergoing initial repair of coarctation between 1960 and 2008. During that time, 103 patients (10%) required reintervention. Median age at reintervention was 6.5 years (range, 2 weeks to 44 years) and median weight was 12 kg (range, 1.9 to 94 kg). Fifty-nine patients with recoarctation had surgical repair, and 44 patients were treated with balloon aortoplasty with or without stent placement., Results: Ninety-five percent of patients have been followed up (median time, 14.2 years; range, 2 months to 42 years). There were 5 late deaths. Actuarial survival was 98% at 15 and 40 years in patients with surgical reintervention, and it was 91% (p = 0.001) at 15 years in patients with balloon aortoplasty reintervention. A second redo coarctation of the aorta reintervention was performed in 12 patients: 8 patients after percutaneous intervention (nonsurgical) and 4 patients after surgical recoarctation repair. The median interval between first and second reintervention was 3.5 years (range, 1 month to 14 years). One patient who had two dilations underwent a third and fourth reintervention: patch enlargement and pseudoaneurysm resection. Freedom from reintervention in the surgical group was 96% at 15 years and 94% at 40 years, which was compared with actuarial freedom from reintervention for patients with percutaneous intervention (balloon/stent) at 15 years (82%; p < 0.001)., Conclusions: Our study demonstrates that surgical repair of recurrent coarctation of the aorta can be performed safely and with excellent results. The recurrence after surgical reintervention is low, and most patients to date have not required further intervention. Balloon aortoplasty as an alternative method of managing recoarctation is efficient and less invasive than surgery; however, well-described complications may occur. Recurrence rates with angioplasty are significantly higher than with surgery.

Objective: To present our institutional experience of endovascular stent therapy in patients with complex aortic arch lesions., Background: The management of aortic arch obstructions is complex and many physicians are either reluctant to treat mild-moderate aortic arch lesions associated with systemic hypertension or instead refer to high-risk surgical alternatives. Reported data on transcatheter stent therapy of complex aortic arch lesions are scarce., Methods: Between October 2002 and November 2006, 40patients (pts) had complex aortic arch lesions treated with stent implantation in 42 procedures (proc). Aortic arch hypoplasia was present in 30/42 proc (71.4%). The median age was 10 year (16 days - 37 years). In 40/42 proc (95.2%) patients had previous transcatheter or surgical aortic arch interventions., Results: Procedural success in achieving a peak systolic gradient reduction to or=90% of the "normal" adjacent aortic arch was achieved in 38/42 proc (90.5%). The diameter of the arch obstruction increased from a median of 7.55 mm to a median of 14 mm (P < 0.0001) and the peak systolic gradient was reduced from a median of 23 mm Hg to a median of 2 mm Hg (P < 0.0001). Arch vessels were crossed in 31/42 proc (73.8%). Periprocedural adverse events were encountered in 13/42 proc (30.9%), predominately in patients with a weight below 10 kg or univentricular physiology. The median follow-up was 1 year (32 days - 3.8 years). The incidence of systemic hypertension was significantly reduced from 22/42 (52.4%) before the procedure to 6/39 (15.4%) at the most recent follow-up (P = 0.0005). CT or MRI evaluations were performed in 18 pts, documenting all crossed arch vessels to appear patent., Conclusions: Stenting of complex aortic arch lesions can be performed safely and effectively with excellent, immediate, and midterm results. Patients with a weight below 10 kg or after Hybrid stage I palliation are at increased risk of adverse events. Stents can be placed across major arch vessels without compromising distal perfusion in otherwise normal vasculature., ((c) 2008 Wiley-Liss, Inc.)

Objectives: To evaluate the usefulness of balloon angioplasty for relief of native aortic coarctation, we reviewed our experience with this procedure, with special emphasis on follow-up results., Background: Controversy exists with regard to the role of balloon angioplasty in the treatment of native aortic coarctation., Methods: During an 8.7-year period ending September 1993, 67 neonates, infants and children underwent balloon angioplasty for native aortic coarctation. A retrospective review of this experience with emphasis on long-term follow-up forms the basis of this study., Results: Balloon angioplasty produced a reduction in the peak-to-peak coarctation gradient from 46 +/- 17 (mean +/- SD) to 11 +/- 9 mm Hg (p < 0.001). No patient required immediate surgical intervention. At intermediate-term follow-up (14 +/- 11 months), catheterization (58 patients) and blood pressure (2 patients) data revealed a residual gradient of 16 +/- 15 mm Hg (p > 0.1). When individual results were scrutinized, 15 (25%) of 60 had recoarctation, defined as peak gradient > 20 mm Hg. Recoarctation was higher (p < 0.01) in neonates (5 [83%] of 6) and infants (7 [39%] of 18) than in children (3 [8%] of 36), respectively. Two infants in our early experience had surgical resection with excellent results. Three patients had no discrete narrowing but had normal arm blood pressure and had no intervention. The remaining 10 patients had repeat balloon angioplasty with reduction in peak gradient from 52 +/- 13 to 9 +/= 8 mm Hg (p < 0.001). Reexamination 31 +/- 18 months after repeat angioplasty revealed a residual gradient of 3 to 19 mm Hg (mean 11 +/- 6). Three (5%) of 58 patients who underwent follow-up angiography developed an aneurysm. Detailed evaluation of the femoral artery performed in 51 (88%) of 58 patients at follow-up catheterization revealed patency of the femoral artery in 44 (86%) of 51 patients. Femoral artery occlusion, complete in three (6%) and partial in four (8%), was observed, but all had excellent collateral flow. Blood pressure, echocardiography-Doppler ultrasound and repeat angiographic or magnetic resonance imaging data 5 to 9 years after angioplasty revealed no new aneurysms and minimal (2%) late recoarctation., Conclusions: On the basis of these data, it is concluded that balloon angioplasty is safe and effective in the treatment of native aortic coarctation; significant incidence of recoarctation is seen in neonates and infants; repeat balloon angioplasty for recoarctation is feasible and effective; and the time has come to consider balloon angioplasty as a therapeutic procedure of choice for the treatment of native aortic coarctation.

Despite gratifying immediate results, significant recoarctation at follow-up has been observed after balloon angioplasty of native aortic coarctation. Risk factors for such recurrences have been identified in one of our previous studies. In this study we examined the value of these risk factors in the prediction of recoarctation after balloon angioplasty. During a 6-year period ending in September 1993, 37 infants and children aged 2 days to 15 years underwent balloon angioplasty of native coarctation with resultant reduction in coarctation gradient from 45 +/- 17 (mean +/- SD) to 12 +/- 9 mm Hg (p < 0.001). On the basis of results of 4- to 48-month follow-up catheterization in 30 children, recoarctation developed in 8 (27%) children. The data from these patients were scrutinized to identify subjects that exhibited the previously determined risk factors, namely age < 12 months, size of aortic isthmus less than two thirds the size of the ascending aorta, coarcted aortic segment < 3.5 mm before angioplasty, and coarcted segment < 6.0 mm after angioplasty. Then, thirty variables (Table I) were examined by logistic regression to identify factors responsible for recoarctation; the data from both study groups were combined for this analysis. The prevalence of recoarctation in each subgroup with a given number of risk factors is similar (p < 0.1) to that observed in the initial study identifying the risk factors. In addition, logistic regression identified age (p = 0.014), size of isthmus (p = 0.006), preangioplasty coarcted segment (p = 0.01), and postangioplasty coarcted segment (p = 0.006) as risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Percutaneous transluminal balloon angioplasty has been documented as a useful procedure in the treatment of recurrent coarctation of the aorta. In this project we present our experience and results., Patients and Methods: Percutaneous transluminal balloon angioplasty was performed in 7 children with postsurgical coarctation of the aorta. Six of them had previous coarctation of the aorta and one had a iatrogenic result of a persistent ductus arteriosus operation., Results: Mean pressure difference across the coarctation decreased from mean = 51 +/- 16 mmHg to mean = 14 +/- 6 mmHg after the angioplasty and mean diameter of the aortic lumen at the coarctation site increased from mean = 3.6 +/- 1.4 to mean = 8.7 +/- 1.2 mm. All patients are asymptomatic and normotensive at least during the following two years after the procedure. Only the patient who had iatrogenic coarctation still has a residual gradient of 30 mmHg. There were not any major complications during the procedure or after it., Conclusions: Percutaneous transluminal balloon angioplasty is a safe and effective procedure in the treatment of postsurgical coarctation of the aorta.

Twenty-three adolescent and adult patients with native coarctation of the aorta underwent balloon dilatation. Dissection of the aorta developed in one patient. Data were collected on the remaining 22 patients. They ranged in age from 15 to 55 years (mean 23 +/- 9.2 years). Invasive measurement of the peak systolic gradient (PSG) and biplane angiography were performed before and immediately after angioplasty and at follow-up 4 to 48 months (mean 15 months) later. PSG before dilatation was 37 to 100 mm Hg (mean 66.9 +/- 19.9 mm Hg) and decreased to 0 to 30 mm Hg (mean 9.1 +/- 11 mm Hg) immediately after dilatation (p less than 0.001). Restenosis occurred in two patients 6 months after dilatation, and one patient had an incomplete dilatation. These three patients underwent successful redilatation and remained improved 12 to 19 months later. There was no significant change in gradient at repeat catheterization in the remaining 20 patients. PSG was 0 to 20 mm Hg (mean 5.8 +/- 7.2 mm Hg). Angiography showed that a small aneurysm developed in one patient immediately after dilatation and in another 6 months later. Eleven patients were restudied more than once, and no change in gradient or size of the aneurysm was noted at mean follow-up 25 months after dilatation. This study demonstrated that balloon angioplasty is an effective method of treating adolescent and adult patient with native coarctation of the aorta. However, because of the uncertain natural history of aneurysm after dilatation, this procedure should be considered investigational until much longer follow-up times are available.

Balloon angioplasty of native coarctation of the aorta was performed in 35 consecutive adolescents and young adults, aged 14 to 37 years (mean 22.6 +/- 7.1). Twenty-eight (80%) patients had isolated discrete coarctation, six (17.1%) had tubular hypoplasia of the aortic isthmus, and one (2.9%) had hypoplasia of the post-coarctation aorta. The peak systolic pressure gradient decreased from 78.5 +/- 23.9 to 15.7 +/- 11.6 mm Hg (p less than 0.001), and the mean coarctation diameter increased from 4.7 +/- 2.4 to 13.1 +/- 2.7 mm (p less than 0.001) immediately after angioplasty. Patients with discrete-type coarctation had significantly less residual gradient than patients with long-segment tubular coarctation (12.3 +/- 10.7 vs 27.2 +/- 6.6 mm Hg, p less than 0.01). On recatheterization and angiography in 26 patients at 12.6 +/- 1.5 months after dilatation, there was no significant change in gradient (15.5 +/- 13.3 mm Hg) and diameter (13.1 +/- 1.8 mm) from the immediate post-angioplasty results. However, two patients had an increase in gradient and three had small aortic aneurysms with no change in appearance on restudy after 2 years. After 3 to 67 months' (mean 32.7 +/- 19.2) follow-up, all patients showed continued clinical improvement. Hypertension was relieved in 37.5% (12/32) and improved in 59.4% (19/32). Our experience suggests that balloon angioplasty of native aortic coarctation in adolescents and young adults is safe and highly effective with sustained improvement on intermediate-term follow-up.

Background: As angioplasty techniques have been refined and larger low-profile balloons developed, a nonsurgical approach to recoarctation has become available. Several reports have documented both the efficacy and safety of this procedure. However, there are little data available on the long-term follow-up of these patients. This report details the initial results and long-term evaluation of both the relief of obstruction and the presence of hypertension after balloon angioplasty for recurrent coarctation., Methods and Results: Balloon angioplasty for recurrent coarctation of the aorta was performed 29 times in 26 patients at a median age of 4 years and 9 months (range, 4 months to 29 years), with eight patients less than 1 year old. Initial surgical techniques were end-to-end anastomosis in 11 patients, subclavian flap aortoplasty in 11 patients, and patch aortoplasty in four patients. Angioplasty was performed at a median interval of 2 years and 7 months (range, 4 months to 23 years) after surgery. Mean peak systolic pressure difference across the coarctation decreased from 40.0 +/- 16.8 to 10.3 +/- 9.5 mm Hg (p less than 0.05) after the initial angioplasty, and mean diameter of the aortic lumen at the coarctation site increased from 5.8 +/- 3.5 to 9.0 +/- 4.3 mm (p less than 0.05). There was no mortality, and only one patient developed an aneurysm (4%). Three patients underwent repeat angioplasty for a pressure difference of more than 20 mm Hg. Long-term follow-up is available on 24 of 26 patients with a mean follow-up of 42 +/- 24 months (range, 12-88 months). Mean peak systolic pressure difference across the area of coarctation decreased from 40.3 +/- 17.4 before angioplasty to 8.5 +/- 8.3 mm Hg after final angioplasty (p less than 0.05) and 7.5 +/- 7.5 mm Hg at follow-up. Mean peak systolic blood pressure in the upper extremities decreased from 133.1 +/- 14.9 before angioplasty to 111.1 +/- 14.1 mm Hg at long-term follow-up (p less than 0.05)., Conclusions: Balloon angioplasty should be considered the treatment of choice for relief of recurrent aortic coarctation.

The purpose of this article is to present immediate and follow-up results of balloon angioplasty of aortic recoarctations following previous surgery in infants and children. During a 45-month period that ended in June 1989, nine infants and children, ages 6 months to 7 years, underwent balloon angioplasty of recoarctation with resultant reduction in peak-to-peak systolic pressure gradient from 52 +/- 20 mm Hg (mean +/- SD) to 16 +/- 8 mm Hg (p less than 0.001) and increase in coarctation segment size from 3.4 +/- 1.4 mm to 6.1 +/- 1.6 mm (p less than 0.01). None required surgical intervention. There were no significant complications. Follow-up catheterization (16 +/- 7 months) data in six children and follow-up clinical (17 +/- 6 months) data in all children were available for review. Both the residual coarctation pressure gradient (6 +/- 6 mm Hg) and coarctation segment size (8.2 +/- 2.4 mm) remain improved (p less than 0.001) when compared with pre-balloon angioplasty values and the pressure gradient fell further (p less than 0.01) when compared with that measured immediately after balloon angioplasty. None developed restenosis, although one child required surgical relief of severe narrowing of isthmus of the aortic arch. None developed aneurysms. On the basis of this experience and that reported in the literature and because of high morbidity and mortality rates associated with repeat surgery for postoperative recoarctation, we recommend balloon angioplasty as the procedure of choice for relief of postoperative recoarctation with significant hypertension.