Coarctation and balloons: inflated or realistic?

The use of catheters to dilate vascular obstructions began as early as 1964. In their classic article, Dotter and Judkins (1) described transluminal dilation of arteriosclerotic obstruction. It wasn’t until 10 years later that the use of balloontipped catheters in coronary artery dilations was reported by Gruentzig and Hopff (2) and later applied by Gruentzig and his colleagues (3). Since these reports, multiple uses of balloon catheters to dilate a variety of lesions of the circulatory system have been reported. In pediatrics, the first application of pulmonary balloon valvuloplasty led to widespread reports of success with this technique (4-7). Soon thereafter, other vascular obstructions such as peripheral pulmonary artery stenosis (8), pulmonary vein stenosis (9,10), aortic valve stenosis (11-13) and vena caval obstruction (14) were reported to be amenable to balloon dilation techniques. More recently, patients with coarctation of the aorta have been the subjects of balloon dilation procedures. Perhaps as many as 200 cumulative cases of balloon dilation of coarctation have been reported (U-29), including discrete lesions as well as diffuse coarctation, native coarctation as well as restenosis coarctation and coarctation in infants as well as in older children. Surgical correction of coarctation of the aorta has been successfully performed for >40 years (30). A variety of modifications of the classic end to end anastomosis has been described, all with advantages and disadvantages (31). Complications have included recurrence of stenosis, especially if the original operation was performed in infancy, and persistent hypertension, notable when surgical relief has been postponed (32-35). Of course, operative risk per se, postoperative paresis and paradoxic hypertension have all been associated with surgical correction of coarctation. These would be avoided by the use of the balloon dilation technique .