Abstract

Objective: Coarctation of the aorta is a congenital anomaly observed in 8% to 10% of all cases of congenital heart disease. In patients with postoperative aortic recoarctation, reoperation is associated with high morbidity and mortality risk, and percutaneous balloon angioplasty is widely accepted as a first-line option in these patients regardless of the primary surgery or recoarctation anatomy. Our aim in this study was to share our experience with balloon angioplasty in patients who developed recoarctation after surgery for aortic coarctation.

Methods: A total of 39 patients aged 0-18 years who underwent percutaneous balloon angioplasty in the Pediatric Cardiology Department of Ege University between January 2010 and January 2020 were included in the study. All of the patients developed aortic recoarctation after surgical repair of aortic coarctation and were referred from various centers.

Results: On echocardiography performed before balloon angioplasty, the mean pressure gradient between the ascending and descending aorta was 50±11 mmHg. Transcatheter peak systolic pressure gradient between the ascending and descending aorta was 35 ± 13 mmHg before the procedure and decreased to 8 ± 11 mmHg after the procedure. The mean balloon diameter used for balloon angioplasty was 10 ± 4 mm. Adequate gradient reduction was achieved in all patients during balloon angioplasty. No major complications were observed. In our study, after balloon angioplasty, the prevalence of recoarctation was 7%.

Conclusion: In conclusion, balloon angioplasty can be used safely in the treatment of postoperative recoarctations.

Keywords: Recoarctation, balloon angioplasty, aortic, surgery

Copyright and license

Copyright © 2023 The author(s). This is an open-access article published by Aydın Pediatric Society under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Doğan E, Aydın D, Ülger Z, Levent E. Balloon angioplasty for postoperative aortic recoarctation in children: A 10-year, single-center experience. Trends in Pediatrics. 2023;4(1):31-36. https://doi.org/10.59213/TP.2023.97269

References

  1. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118:e714-833. https://doi.org/10.1161/circulationaha.108.190690
  2. Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg. 1945;14:347-61. https://doi.org/10.1016/S0096-5588(20)31801-8
  3. Erdoğan HB, Ardal H, Ömeroğlu SN, et al. Aort koarktasyonu cerrahi tedavisi: Yirmi yıllık deneyim. Türk Göğüs Kalp Damar Cer Derg 2006;14:117-21.
  4. Bouchart F, Dubar A, Tabley A, et al. Coarctation of the aorta in adults: surgical results and long-term follow-up. Ann Thorac Surg. 2000;70:1483-8; discussion 1488-9. https://doi.org/10.1016/s0003-4975(00)01999-8
  5. Knyshov GV, Sitar LL, Glagola MD, Atamanyuk MY. Aortic aneurysms at the site of the repair of coarctation of the aorta: a review of 48 patients. Ann Thorac Surg. 1996;61:935-9. https://doi.org/10.1016/0003-4975(95)01189-7
  6. Brown ML, Burkhart HM, Connolly HM, et al. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol. 2013;62:1020-5. https://doi.org/10.1016/j.jacc.2013.06.016
  7. Lehnert A, Villemain O, Gaudin R, Méot M, Raisky O, Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg. 2019;29:469-75. https://doi.org/10.1093/icvts/ivz117
  8. Singer MI, Rowen M, Dorsey TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J. 1982;103:131-2. https://doi.org/10.1016/0002-8703(82)90539-7
  9. Rao PS, Chopra PS. Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg. 1991;52:621-31. https://doi.org/10.1016/0003-4975(91)90961-o
  10. Wong D, Benson LN, Van Arsdell GS, Karamlou T, McCrindle BW. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young. 2008;18:79-88. https://doi.org/10.1017/S1047951107001795
  11. Tynan M, Finley JP, Fontes V, Hess J, Kan J. Balloon angioplasty for the treatment of native coarctation: results of valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol. 1990;65:790-2. https://doi.org/10.1016/0002-9149(90)91389-n
  12. Beekman RH. Coarctation of the aorta. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF, editors. Moss and Adam's Heart Disease in Infants, Children and Adolescents. 7th ed. Philedelphia: Lippincott Williams & Wilkins; 2008:987-1005.
  13. Reich O, Tax P, Bartáková H, et al. Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents. Eur Heart J. 2008;29:2042-8. https://doi.org/10.1093/eurheartj/ehn251
  14. Lee CL, Lin JF, Hsieh KS, Lin CC, Huang TC. Balloon angioplasty of native coarctation and comparison of patients younger and older than 3 months. Circ J. 2007;71:1781-4. https://doi.org/10.1253/circj.71.1781
  15. Nguyen L, Cook SC. Coarctation of the aorta: strategies for improving outcomes. Cardiol Clin. 2015;33:521-30, vii. https://doi.org/10.1016/j.ccl.2015.07.011
  16. Roos-Hesselink JW, Schölzel BE, Heijdra RJ, et al. Aortic valve and aortic arch pathology after coarctation repair. Heart. 2003;89:1074-7. https://doi.org/10.1136/heart.89.9.1074
  17. Kappetein AP, Gittenberger-de Groot AC, Zwinderman AH, Rohmer J, Poelmann RE, Huysmans HA. The neural crest as a possible pathogenetic factor in coarctation of the aorta and bicuspid aortic valve. J Thorac Cardiovasc Surg. 1991;102:830-6.
  18. Mitchell ME. Aortic coarctation repair: How I Teach It. Ann Thorac Surg. 2017;104:377-81. https://doi.org/10.1016/j.athoracsur.2017.03.084
  19. Dijkema EJ, Sieswerda GT, Takken T, et al. Long-term results of balloon angioplasty for native coarctation of the aorta in childhood in comparison with surgery. Eur J Cardiothorac Surg. 2018;53:262-8. https://doi.org/10.1093/ejcts/ezx239
  20. Karamlou T, Bernasconi A, Jaeggi E, et al. Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg. J Thorac Cardiovasc Surg. 2009;137:1163-7. https://doi.org/10.1016/j.jtcvs.2008.07.065
  21. Egunov OA, Krivoshchekov EV, Cetta F, Sokolov AA, Sviazov EA, Shipulin VV. Surgery for aortic recoarctation in children less than 10 years old: a single-center experience in Siberia, Russia. J Card Surg. 2022;37:1627-32. https://doi.org/10.1111/jocs.16435
  22. Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg. 2013;145:150-7; discussion 157-8. https://doi.org/10.1016/j.jtcvs.2012.09.053
  23. Hornung TS, Benson LN, McLaughlin PR. Interventions for aortic coarctation. Cardiol Rev. 2002;10:139-48. https://doi.org/10.1097/00045415-200205000-00002
  24. Cowley CG, Orsmond GS, Feola P, McQuillan L, Shaddy RE. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation. 2005;111:3453-6. https://doi.org/10.1161/CIRCULATIONAHA.104.510198
  25. Salcher M, Naci H, Law TJ, et al; Cardioproof Consortium. Balloon dilatation and stenting for aortic coarctation: a systematic review and meta-analysis. Circ Cardiovasc Interv. 2016;9:e003153. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003153
  26. Rao PS, Galal O, Smith PA, Wilson AD. Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol. 1996;27:462-70. https://doi.org/10.1016/0735-1097(95)00479-3
  27. Ovaert C, McCrindle BW, Nykanen D, MacDonald C, Freedom RM, Benson LN. Balloon angioplasty of native coarctation: clinical outcomes and predictors of success. J Am Coll Cardiol. 2000;35:988-96. https://doi.org/10.1016/s0735-1097(99)00646-4
  28. Dilawar M, El Said HG, El-Sisi A, Ahmad Z. Safety and efficacy of low-profile balloons in native coarctation and recoarctation balloon angioplasty for infants. Pediatr Cardiol. 2009;30:404-8. https://doi.org/10.1007/s00246-008-9317-x