THERAPY AND PREVENTION CONGENITAL HEART DISEASE Balloon dilatation angioplasty: nonsurgical management of coarctation of the aorta

Balloon dilatation angioplasty was successfully performed in five patients (ages 18 months to 17 years) with discrete aortic coarctation. The catheter size was No. 8F or 9F. Selection of balloon diameter was based on angiographic measurements of the aorta determined proximal and distal to the coarctation site. A 10 sec inflation-deflation cycle at 6 to 8 atmospheres (90 to 120 psi) was performed. The systolic pressure gradients across the coarctation before balloon dilatation angioplasty ranged from 35 to 70 mm Hg. Systolic pressure gradients after balloon dilatation angioplasty ranged from 0 to 10 mm Hg. All patients had normalized blood pressure immediately. Abnormal pulsed Doppler echocardiograms were observed in all patients before balloon dilatation angioplasty; four patients had normal echocardiograms after balloon dilatation angioplasty. No serious intraprocedural complications occurred. One patient required femoral artery thrombectomy 36 hr after balloon dilatation angioplasty. One to 6 months after balloon dilatation angioplasty no patients have evidence of restenosis of coarctation. Early results suggest that balloon dilatation angioplasty may offer a safe and effective nonsurgical alternative for the treatment of discrete coarctation in older infants and children. Long-term follow-up for the incidence of restenosis and formation of aneurysms will ultimately determine the efficacy and safety of this procedure. Circulation 70, No. 5, 903-907, 1984. THE INTRODUCTION and availability of balloon dilatation catheters has led to the use of percutaneous transluminal angioplasty in infants and children with congenital heart disease. The conditions that have been treated with this technique include pulmonary valvular stenosis, ' 4aortic valvular stenosis,5 6 peripheral pulmonary artery7 and pulmonary vein stenosis,5 9 superior and inferior vena caval obstruction, '° 1 l coarctation of the aorta,'2"-7 and restenosis of coarctation.'5 This report describes the results of balloon dilatation angioplasty in five patients with discrete coarctation of the aorta. In addition, pulsed Doppler echocardiography was used to assess this condition before and after balloon dilatation.