New Predictors of Long-Term Results of Balloon Angioplasty in Aortic Coarctation

The aim of the investigation was to determine anatomic parameters that enable to predict a long-term outcome of transluminal balloon angioplasty of aortic coarctation.

Materials and Methods. Transluminal balloon angioplasty of aortic coarctation was performed in 51 patients, aged from 1.5 months to 35 years (mean age 6.6±6.1 years). Pressure gradient in the area of aortic isthmus stenosis varied from 31 to 103 mm Hg. The patients were followed up according to the findings of clinical examination with systemic arterial pressure measurement, echocardioscopy and multispiral computed tomography findings.

Long-term results were assessed in 32 patients (62.7%) divided into groups by the residual pressure gradient value in aortic isthmus in a long-term period after the angioplasty. Group 1 included 21 patients (65.6%) with residual pressure gradient not exceeding 20 mm Hg according to echocardiography findings; group 2 — 6 patients (18.8%) with the gradient of 21–35 mm Hg, group 3 — 5 patients (15.6%) with the gradient over 35 mm Hg.

Results. The group 2 patients in a long-term period after balloon angioplasty were statistically significantly proven to have aortic lumen sufficient for maintaining adequate hemodynamics for a long time without significant strain of adaptive forces due to the stabilization of values (plateau effect). We revealed two anatomic parameters of aortic isthmus that have effect on a long-term result of angioplasty: the coarctation length and the distance from the left subclavian artery orifice to coarctation.

Conclusion. After angioplasty the patients with the isthmus residual gradient being from 21 to 35 mm Hg in a long-term period pass into a group of patients with more favorable clinical progression of the disease. In pediatric subjects in this group the repeated correction can be delayed up to the termination of physiological growth of aorta.
For prognosis of a long-term result of transluminal balloon angioplasty there can be used such parameters as the length of the stenosis area and the distance from the left subclavian artery orifice to coarctation, the coarctation length being the most accurate parameter. The best results can be obtained if the coarctation area is less than 5 mm and the distance from the left subclavian artery orifice to coarctation is over 12 mm.

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Gasnikov А.V., Fokin А.А., Vladimirsky V.V. New Predictors of Long-Term Results of Balloon Angioplasty in Aortic Coarctation. Sovremennye tehnologii v medicine 2013; 5(2): 65