Immediate and Midterm Results of Early Balloon Angioplasty for Recurrent Aortic Coarctation in Children under 1 Year of Age

Background: Balloon angioplasty for the treatment of recurrent coarctation after surgical resection of a stenosis of the aortic isthmus has been established as a safe procedure with good results and often avoids the need of stent applications. Only a few studies have shown results in children under one year of age.

Methods: The data of 33 patients (female 51.5%) aged 3.8 months (0.5–11.5 months) who underwent corrective surgery for aortic coarctation at our hospital at the age of 0.7 months (0.1–2.4 months) were retrospectively reviewed. Echocardiographic and angiographic data were evaluated, and further follow-up was analyzed.

Results: Due to the dilatation, the peak-to-peak gradient fell from 39.9 ± 20.5 mm Hg to 21.0 ± 12.5 mm Hg (p < 0.001). The diameter of the stenosis increased from 3.5 ± 1.9 mm to 4.4 ± 1.9 mm (p < 0.001); z-scored from −3.87 ± 2.55 to −2.27 ± 1.99 (p < 0.001). Right arm systolic blood pressure was reduced from 109.9 mm Hg to 96.9 mm Hg (p < 0.001). The systolic blood pressure gradient (relevant gradient ≥20mmHg) between right arm and left leg was reduced in 11/27 (40.7%) cases (p = 0.006). Re-coarctation was more frequent in patients with concomitant malformations, 90.9%. Complex heart disease was observed in 45.5%, 95% CI Pearson–Clopper [28.1%; 63.6%] and included additional aortic arch hypoplasia (60.0%), TGA (46.7%), hypoplastic right or left ventricle (40.0%), double inlet left ventricle (20.0%), Shone′s complex (13.3%), Taussig–Bing anomaly (13.3%), subvalvular aortic stenosis (13.3%), tricuspid atresia (6.7%), interrupted aortic arch (6.7%), double aortic arch (6.7%) and double outlet right ventricle (6.7%). Complications occurred in 15.2% and included circulatory disorders (6.1%), bleeding events (6.1%) or cardiac arrhythmia (3.0%). 42.4% of the patients required further cardiac catheter interventions (2+ re-interventions). Age (p = 0.926, OR 1.000), complex heart disease (p = 0.128, OR 4.509) and initial peak gradient (p = 0.587, OR 1.013) were not a risk factor for the need of further intervention. After 1 year follow-up time, the peak echocardiographic gradient was 27.4 ± 10.2 mm Hg (n = 17), after 2 years 24.6 ± 8.3 mm Hg (n = 14), after 5 years 32.8 ±18.8 mm Hg (n = 14), and after 7 years 35.4 ± 23.2 mm Hg (n = 13).

Conclusion: Early dilatation of recurrent aortic coarctation is a safe intervention with low risk and high success rate. Re-coarctation is more common in patients with concomitant malformations. Further need for intervention is associated with a good outcome.

Publication History

Article published online:
13 February 2024