Percutaneous Balloon Angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months： Medium- to Long-term Follow-up

Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.

Early and mid-term outcomes of Cheatham platinum stent for the native aortic coarctation

Background Aortic coarctation(CoA)is a common congenital cardiovascular defect. Until now,there is no unified conclusions about the therapeutic options of the native aortic coarctation(CoA)in adolescents and adults. Methods From May 2010 to April 2018,consecutive 23 patients(median age 25 years,range 15-57 years)with native CoA underwent endovascular repair by applying covered Cheatham platinum(CP)stent in our center. Related variables were retrospectively collected and analyzed. Results Ten cases were complicated with other congenital heart diseases. Hypertension was confirmed in 21(91.3%)patients. In these patients,thirteen cases(61.9%)had a normal blood pressure without drug treatment during follow-up.The systolic right arm blood pressure significantly decreased from a mean of 150.7±6.4 mmHg pre-operation to 128.0±12.5 mmHg discharge(P<0.001),and the diastolic pressure decreased from 82.0±10.0 to 73.1±6.8 mmHg(P<0.001). The diameter of the coarcted segment increased from 5.0±2.3 to 16.9±2.3 mm(P<0.001). The peak systolic gradient significantly decreased from 64.9±20.9 to 7.1 ±6.1 mm Hg(P<0.001). The median follow-up was 30 months(range 1 months to 7.9 years). Complications were found in 4 people within one month:1 suspected cardiovascular-related death,1 new aortic dissection,1 splenic infarction,and 1 path-related arterial occlusion.Conclusions Our limited experience demonstrated that stent implantation is a reliable technique for the management of native aortic coarctation in adolescents and adults. Our intermediate-term results seem encouraging,however,the early complications should be considered. A larger series of cases with a longer follow-up is needed to substantiate these results.