Introduction
Recurrent stenosis after repair of aortic coartation is not an uncommon clinical occurrence. This study values the results and the follow-up of post surgical recoartation treatment, either with balloon valvuloplasty and surgical aortic arch reconstruction, in patients initially operated under 1 year of age.
Materials and Methods
Between February 1998 and December 2008 we followed 173 infants previously operated, under one year of age, of aortic coartacion repair (simple/complex). The re-coartation rate was 24.2% (42 patients); as first treatment, 37 patients underwent balloon angioplasty, which was initially effective in 32 (group A) and 5 patients directly underwent reparative surgery (group B), including 5 additional patients, coming from the initial angioplasty group.Echocardiographic,hemodynamic,angiographic,MRN data were review.
Results
A successful balloon angioplasty was achieved in 32/37 patients (86.4%;6 of these 37 patients underwent subsequent surgery. In group A (effective angioplasty), peak gradient decreased from 38 ± 16 to 9 ± 6 mmHg (p < 0.001). In group B (surgical aortoplasty), peak gradient decreased from 56 ± 20 to 15 ± 17 mmHg (p < 0.001). During 10 years of follow-up, the restenosis rate was 1/10 (10%) in group B and 6/32 (18.7%) in group A; two of these 6 patients underwent a new successful angioplasty and four underwent surgical repair .
Conclusion
Balloon angioplasty can be safely performed in infants with good term results. The risk of restenosis is low, and can be successfully managed with repeat angioplasty. The need for further surgical intervention in those with transverse arch hypoplasia remains high.