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European Heart Journal Advance Access published online on June 10, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn251
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents

Oleg Reich1,2,*, Petr Tax1, Helena Bartáková1, Viktor Tomek1, Jirí Gilík1, Jirí Lisy3, Jirí Radvansky4, Tomás Matejka1, Tomás Tláskal1, Irena Svobodová1, Václav Chaloupecky1 and Jan Skovránek1

1 Kardiocentrum and Cardiovascular Research Centre, University Hospital Motol, Vúvalu 84, Prague 150 18, Czech Republic
2 Department of Paediatrics, Charles University, Prague, Czech Republic
3 Department of Imaging Methods, Charles University, Prague, Czech Republic
4 Department of Exercise Medicine, 2nd Medical School, Charles University, Prague, Czech Republic

Received 19 November 2007; revised 15 April 2008; accepted 23 May 2008.

* Corresponding author. Tel: +420 224432968, Fax: +420 224432920, Email: oleg.reich{at}lfmotol.cuni.cz


   Abstract
Top
 Abstract
Introduction
 Patients
 Methods
 Results
 Discussion
 Conclusions
 Funding
 Acknowledgements
 References
 
Aims: To assess the efficacy, safety, and long-term results of the balloon angioplasty of recoarctation.

Methods and results: The angioplasty was performed in 99 consecutive patients aged 36 days to 32.6 years (median 268 days). Recoarctation to descending aorta diameter ratio increased from 0.44 (0.35/0.50) to 0.66 (0.57/0.77), P < 0.001. Systolic gradient was reduced from 34.0 (26.0/44.75) to 15.0 (8.25/27.0) mmHg, P < 0.001. In seven patients (7.1%) the procedure was ineffective. One patient (1%) with heart failure died within 24 h after a successful angioplasty and in another (1%) an intimal abruption necessitated surgical revision. The follow-up ranged up to 20.7 years (median 8.1 years). Actuarial probability of survival 20.7 years after the procedure was 0.91, and of reintervention-free survival was 0.44. Older age at the angioplasty was associated with a higher incidence of reinterventions (hazard ratio 1.057; 95% confidence interval 1.012–1.103; P = 0.010). The type of surgery and the recoarctation anatomy did not influence the outcome. In 69 patients aneurysm formation was studied by high-sensitive methods with only one positive finding per 462 patient-years.

Conclusion: Angioplasty is safe and effective regardless of the type of surgery used and the recoarctation anatomy. Older age at the angioplasty is associated with a higher incidence of reinterventions.

Key Words: Congenital heart defect • Coarctation of the aorta • Balloon angioplasty • Aneurysm • Long-term results


   Introduction
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 Abstract
 Introduction
Patients
 Methods
 Results
 Discussion
 Conclusions
 Funding
 Acknowledgements
 References
 
After experimental trials,1–3 percutaneous balloon angioplasty was established as a treatment option both for native4 and recurrent postoperative aortic coarctation.5 In large multi-centre studies of short-term results, the angioplasty of the recurrent aortic coarctation was effective in 75–79% of patients with mortality of 0.7–2.5%.6,7 Due to the balloon dilation, tears, dissections, and subsequent aneurysm formation may affect the aortic wall. Such complications have been reported in up to 17% of cases.8 So far, three studies on long-term results of recoarctation angioplasty have been published with median follow-up periods of 3–5 years and controversial outcomes, e.g. reintervention rates varied between 6 and 53%.9–11

We present a retrospective study on 99 consecutive patients with the postoperative recoarctation treated by the balloon angioplasty with a follow-up period of up to 20 years. The purpose of the study was to evaluate short-term and long-term results of the angioplasty.


   Patients
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 Abstract
 Introduction
 Patients
Methods
 Results
 Discussion
 Conclusions
 Funding
 Acknowledgements
 References
 
Since August 1986, percutaneous balloon angioplasty without a stent implantation has been used in our institution as the first choice method of treatment of recurrent aortic coarctation after a previous coarctation surgery. The procedure was indicated in all the patients with arm–leg pressure gradient ≥20 mmHg and Doppler echocardiographic findings of typical coarctation flow patterns in the isthmus and the descending aorta. Up to May 2007, a total of 99 consecutive patients were treated with the angioplasty and they all were included in this retrospective study. All of them had had a surgery for aortic coarctation at a median age of 13 days (1 day to 15.8 years). In 63 patients the coarctation was isolated and in 36 it was accompanied by other congenital heart defects (Table 1). The surgery for coarctation was resection and end-to-end anastomosis in 78 patients, subclavian flap aortoplasty in 10, resection and extended anastomosis in seven, resection along with subclavian flap aortoplasty in two, and resection with reverse subclavian flap aortoplasty in two patients. The recoarctation angioplasty was performed at a median age of 268 days (36 days to 32.6 years). At the time of angioplasty, 53 patients (53.5%) were infants <1 year of age. The median interval between the surgery and the angioplasty was 259 days (32 days to 21.4 years).


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  		Table 1 Congenital heart defects associated with the coarctation

 

   Methods
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 Abstract
 Introduction
 Patients
 Methods
Results
 Discussion
 Conclusions
 Funding
 Acknowledgements
 References
 
Angiographic assessment
Aortograms in lateral projection were used for measurements. Diameters of transversal aortic arch and recoarctation were expressed as a fraction of the diameter of the descending aorta at the diaphragm level. Recoarctation diameter to recoarctation length ratio was calculated to distinguish discrete and tubular lesions.

Balloon angioplasty
The method had been approved by the hospital ethics committee and all the patients or their guardians signed an informed consent form before the treatment. Based on aortography measurements, dilation balloons smaller than or equal to the diameter of the descending aorta at the diaphragm level that did not exceed three times the diameter of the narrowest recoarctation site were used. The mean (SD) balloon to recoarctation diameter ratio was 2.25 (0.70) and the balloon to the descending aorta diameter ratio was 0.92 (0.19). The balloon catheter was positioned over the wire to straddle the recoarctation and inflated to the appropriate working pressure using a manometer-equipped inflation syringe. The balloon was promptly evacuated after its waist disappeared. If, however, the waist persisted, the balloon inflation was maintained for 60 s. In resistant lesions repeated inflations were performed.

Follow-up
Follow-up extended up to 20.7 years after the angioplasty (median 8.1 years, total of 841 patient-years). One patient (1.0%) was lost to follow-up with the latest data available at 191 days after the angioplasty. In 10 patients (10.1%), records from their local cardiologists were obtained. All others (88.9%) were seen at our outpatient clinic and studied by complete echocardiography. In 69 patients (69.7%), objective information other than echocardiography was available on possible aneurysm formation at the site of the angioplasty at 5 days to 19.6 years, median 5.3 years after the procedure. The information was obtained by magnetic resonance imaging (MRI) in 40 patients, by repeated aortic isthmus surgery in 16, by biplane angiography in nine, and by necropsy in four patients. In the patient lost to follow-up the last available data were used for analyses, and in the patients who required a reintervention or died, the last data before surgery or death were used.

Blood pressure measurements
Blood pressure measurements on arms and legs were taken by cuffs bladders covering at least 2/3 and completely encircling the appropriate limb segment. Auscultation of the Korotkoff phenomena was used in older children and Doppler ultrasound in infants. The pressures Z-scores were calculated using the algorithm given in Appendix B of ‘The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents'. Patients with systolic blood pressure Z-score >1.645 were considered hypertensive.12

Echocardiography
Aortic anatomy and character of flow were studied using two-dimensional (2D) echocardiography, pulsed- and continuous-wave Doppler, and colour flow mapping. Flow and pulsation of the descending aorta at the diaphragm level were assessed from a subcostal approach in the sagittal plane. The aortic arch, isthmus, and the thoracic aorta were studied from suprasternal and subclavicular approaches. Peak instantaneous flow velocities in the recoarctation area before the angioplasty, after the angioplasty, and at the latest follow-up were compared to assess changes in haemodynamic significance of the narrowing.

Magnetic resonance imaging
Gadolinium-enhanced ECG-triggered MRI examination of the thoracic aorta was performed using a 1.5 T-system. General anaesthesia was used in small children. The imaging protocol consisted of axial T2-weighted turbo spin-echo, axial-balanced fast-field echo, oblique sagittal turbo spin-echo, oblique sagittal-balanced fast-field echo, transversal 2D timing test bolus, and oblique sagittal contrast-enhanced 3D T1 weighted fast-field echo sequences. Raw data images from the latest sequence were used to measure the aortic lumen diameters.

Statistics
The data sets were tested for normal distribution and for equal variance when they were compared. If normal distribution and equal variance were proved, the data were compared by parametric tests and the results are displayed as mean (SD). Otherwise the data were compared by non-parametric tests and the results are displayed as median (25th centile/75th centile). All the tests were two-sided. Data obtained prior to the angioplasty and immediately after the angioplasty were compared using a paired t-test or the Wilcoxon signed rank test. The significance of changes over the follow-up period was assessed by the Pearson's correlation of the follow-up times and differences between the latest follow-up and the immediate post-procedure values of the studied parameters expressed in percentage of the post-procedure value. Differences between subgroups were tested by t-test or by the Mann–Whitney rank sum test. Univariate Cox proportional hazard analyses were used to assess association of the baseline anatomic and procedural covariates to the angioplasty outcome (need for reinterventions). The Kaplan–Meier estimate was used to calculate actuarial probabilities and the Gehan–Breslow test (Holm–Sidak method) was used for their comparison. Results with a probability value of P < 0.05 were considered significant.


   Results
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 Abstract
 Introduction
 Patients
 Methods
 Results
Discussion
 Conclusions
 Funding
 Acknowledgements
 References
 
Short-term results
Early mortality
Two infants (2.0%) died early after the procedure. One patient aged 74 days, who also had a double-inlet left ventricle, died several hours after emergency balloon angioplasty from persistent heart failure. Angiographically the recoarctation to descending aorta diameter ratio was enlarged from 0.73 to 0.93 and at post-mortem examination no complication of the procedure was found. The other patient with a ventricular septal defect and pulmonary arterial banding died of intercurrent respiratory disease 10 days after the angioplasty at the age of 42 days.

Procedural complications
In one infant (1.0%) aged 201 days, an abruption of a large intimal flap that caused a partial obstruction to the aortic arch flow necessitated an urgent surgical revision. At the time of the revision, the aortic isthmus was enlarged by a patch and the recovery was uneventful. There were no other procedure-related complications.

Recoarctation diameter
By aortography measurements before and after the angioplasty, the ratio of the recoarctation diameter to the diameter of descending aorta at the diaphragm level increased from 0.44 (0.35/0.50) to 0.66 (0.57/0.77), P < 0.001 (Figure 1).


Figure 1
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  		Figure 1 Early results. Data before and immediately after the angioplasty (DAO, diameter of descending aorta at the diaphragm level; RECOA, recoarctation, narrowest recoarctation diameter).

 
Pressure gradients and peak velocity of flow
Catheter-measured systolic gradient was reduced from 34.0 (26.0/44.75) to 15.0 (8.25/27.0) mmHg, P < 0.001, and the mean gradient 11.5 (9.0/17.0) to 6.0 (2.0/10.0) mmHg, P < 0.001. The arm–leg gradient dropped from 40.0 (30.0/50.0) to 0.0 (0.0/20.0) mmHg, P < 0.001. Echo-Doppler peak velocity of flow decreased from 3.63 (0.56) to 2.78 (0.69) m/s, P < 0.001 (Figure 1).

Blood pressure
Systolic pressure Z-score decreased from 4.42 (2.70/5.82) to 2.49 (1.72/4.07), P < 0.001. Seventy patients (70.7%), however, remained hypertensive shortly after the procedure (Figure 1). There were no differences between the normotensive and hypertensive patients in the post-procedure recoarctation to descending aorta diameter ratio, 0.68 (0.12) vs. 0.67 (0.16), P = 0.697; systolic gradient, 13.5 (10.0/25.0) vs. 15.0 (7.0/27.0) mmHg, P = 0.833; mean gradient, 5.0 (2.0/10.0) vs. 6.0 (2.0/10.0) mmHg, P = 0.918; and peak flow velocity, 2.7 (2.5/3.3) vs. 2.7 (2.5/3.2) m/s, P = 0.899.

Long-term results
Late mortality
Six patients died 35 days to 8.5 years after the angioplasty. Three patients died from a concomitant heart disease, two from Williams syndrome with severe pulmonary branches stenoses and one after a ventricular septal defect closure in a pulmonary hypertensive crisis. One patient died of severe pneumonia 4.2 years after the angioplasty. Two deaths may be attributed to the recoarctation or its treatment, both in adult patients. One patient died suddenly on exertion 6 weeks after a patch enlargement of the recoarctation that took place 20 months after the angioplasty. No clear cause of death was proved by autopsy and accordingly malignant arrhythmia is suspected. The other patient died of sudden aortic bleeding that occurred 28 h after a stent implantation into the recoarctation performed 4.2 years after the original angioplasty. During emergency surgery, a tear of apparently weakened aortic wall was identified medially at the proximal edge of the Palmaz P4014 stent.

Recoarctation diameter
The diameter measurements were available late in the follow-up in 49 patients, in nine by aortography before a repeated angioplasty and in 40 by MRI. There was not a significant correlation between the follow-up times and the differences between the latest follow-up and immediate post-procedural values of the recoarctation to descending aorta diameter ratio (R = –0.060, P = 0.681).

Blood pressure, pressure gradients, and peak velocity of flow
There were no significant correlations between the follow-up times and the differences between the latest follow-up and immediate post-procedural values of the systolic pressure Z-score (R = 0.064, P = 0.551), the arm–leg gradient (R = –0.028, P = 0.788), and the peak velocity of flow through the aortic isthmus (R = 0.157, P = 0.142).

Aneurysm formation
Aneurysms were not detected by routine echocardiography in any of the studied patients. In one adult patient 5.5 years after the angioplasty, MRI however disclosed an 18.6 mm wide and 20.5 mm long aneurysm of the aortic isthmus. When aware of the MRI finding, the formation could be visualized also by echocardiography using non-standard projections. This was the only aneurysm found in the 69 patients studied during the follow-up period with high-sensitivity methods (MRI, aortography, surgical, and necropsy findings) – one per 462 patient-years.

Reinterventions
Despite the favourable trends described earlier, individual patients required reinterventions. The indication was based on an arm–leg gradient >20 mmHg and the detection of typical coarctation flow patterns in the isthmus and the descending aorta using Doppler echocardiography. During the 841 patient-years of follow-up, a reintervention was performed in a total of 28 patients, in seven for insufficient recoarctation relief, in 20 for its recurrence, and in one to correct a procedural complication. In nine patients a repeated balloon angioplasty was performed 288 days to 16.4 years (median 8.5 years) after the initial one. In seven of those patients, a stent was deployed at the time of the repeated procedure. In one of the other two, subsequent surgery was necessary to resolve the recoarctation while the other one is awaiting surgery with significant gradient and medically uncontrollable hypertension. Including the patient after repeated angioplasty, surgery for recoarctation was necessary in 19 patients 5 days to 13.9 years (median 1.5 years) after the angioplasty. In one of them a late aneurysm was repaired at the time of the recoarctation surgery. Surgery was needed to correct an intimal flap abruption in an additional patient.

Predictors of outcome
Out of all the baseline covariates with a possible effect on the angioplasty outcome, only the age at the angioplasty was significantly related to the need for reinterventions (hazard ratio 1.057; 95% confidence interval 1.012–1.103; P = 0.010). Age at the coarctation surgery, surgical technique, angioplasty balloon to recoarctation diameter ratio, and the recoarctation anatomy were not related to the outcome (Table 2).


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  		Table 2 Association of baseline anatomic and procedural covariates with the need for reintervention

 
Actuarial analysis
For the whole cohort, the mean (SEM) actuarial probability of survival 20.7 years after the procedure was 0.91 (0.03), of surgery-free survival 0.65 (0.07), and of reintervention-free survival 0.44 (0.11). The probabilities in the patients treated at the age of <1 year did not differ from those in the patients treated later. Actuarial probabilities in the subgroups were as follows: Survival – infants 0.87 (0.05), older patients 0.95 (0.04), P = 0.076; surgery-free survival – infants 0.79 (0.06), older patients 0.59 (0.09), P = 0.881; reintervention-free survival – infants 0.66 (0.12), older patients 0.40 (0.11), P = 0.776 (Figure 2). Neither of the subgroups differed in the actuarial probability of the freedom from reintervention (with the deceased patients censored): 0.75 (0.13) vs. 0.40 (0.11), P = 0.131.


Figure 2
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  		Figure 2 Actuarial probabilities of survival and event-free survival. Error bars indicate SEM.

 

   Discussion
Top
 Abstract
 Introduction
 Patients
 Methods
 Results
 Discussion
Conclusions
 Funding
 Acknowledgements
 References
 
In the time span of the study, the incidence of recurrent aortic coarctation after surgery in our institution was 8.2% (106 of 1295 operated patients). Our study deals with 99 consecutive mainly paediatric patients treated by percutaneous balloon angioplasty for the recoarctation. Ninety-nine per cent of the patients were followed up for up to 20 years after the angioplasty and in 70% of those, objective information other than echocardiography was available on possible aneurysm formation at the site of the angioplasty. The procedure was effective in widening of the recoarctation diameter and reduction of gradients in 93% of patients. We encountered a single procedural complication. One patient died from heart failure within 24 h after the angioplasty, which was performed in a low cardiac output state and according to current criteria it was technically successful. Another patient died later in the follow-up from bleeding caused by a subsequent recoarctation stenting. All other deaths were not related to the procedure. Throughout 841 patient-years of follow-up, reinterventions for the recoarctation recurrence were needed in 20 patients. The reintervention rate was neither influenced by the type of the coarctation surgery nor by the recoarctation anatomy. One aneurysm per 462 patient-years was detected in patients studied with high-sensitive methods. Actuarial probability of survival 20 years after the procedure was 0.91, of surgery-free survival 0.65, and of reintervention-free survival 0.44. According to the Cox analysis, older age at the angioplasty was associated with a higher incidence of reinterventions. However, the differences between the patients treated in infancy and those treated later in the actuarial probabilities of the freedom from reinterventions and the reintervention-free survival did not yield a statistical significance.

The early results compare with those published so far.6,7 Our procedural mortality was far below the reported 7% mortality after surgical recoarctation repair13 that some authors consider as a highly effective gold standard.14 According to our research, three long-term studies have been published9–11 concerning 26, 33, and 90 patients, respectively. The maximum follow-up periods were 7 (mean 3.5), 10 (median 5), and 12 (median 3.25) years, respectively. Reintervention rates in the studies ranged from 6 to 53%. A study with a follow-up period comparable with ours has not yet been published.

In the extensive multi-centre studies on the short-term outcome,6,7 the effectiveness and the mortality were in an inverse relation, possibly in connection with the dilation strategy used. In an experimental balloon dilation of excised human coarctations,2 intimal tears with extension into the media at the site of the coarctation and transmedial tears in the aorta distal to the coarctation site have been proved. It has been shown on an animal model3 that normal aortas could be stretched by at least 30% without producing any visible vascular injury, that balloon diameters less than twice the diameter of the coarctation had minimal beneficial effect, and that balloon diameters greater than three times the coarctation diameter would often produce transvascular tears and mediastinal haemorrhage. Accordingly, usage of balloons with a diameter 2.5 times the coarctation diameter5 and balloons that would not exceed the diameter of the descending aorta at the diaphragm level15 or the diameter of the aorta proximal to the coarctation site16 have been advocated. Occasionally, however, balloons as big as the largest aortic diameter distal to the obstruction—which generally is the poststenotically dilated segment—have been used.9 Using too large balloons presumably may lead to a higher incidence of adventitial tears and hence a higher incidence of aortic rupture and aneurysm formation. Several aortic ruptures due to the recoarctation angioplasty have been reported.17–20 As compared with a high incidence of the aneurysm formation after the angioplasty of native coarctation,21 a low incidence has been reported in the angioplasty for the recurrent coarctation.11 We have been using balloons with diameters that do not exceed the diameter of the descending aorta at the diaphragm level and are less than three times the diameter of the narrowest recoarctation site. In addition in cases with narrow aortic arch proximally to the recoarctation, we never use balloons that would exceed the aortic arch diameter by >10%. With this policy in place, we have not encountered a fatal procedural complication; the only complication necessitating a surgical revision was a large intimal flap abruption, and a late aneurysm occurred in only one patient.

In accordance with other studies,22 we observed persistent hypertension in many patients in our cohort in spite of otherwise good results of the angioplasty. The fact that immediately after the procedure there were no differences in other procedure outcome measures between the hypertensive and normotensive patients indicates that the residual hypertension may be rather than to the treatment outcome attributed to the disease itself. It has been shown that vessel resistance in the precoarctation vascular bed is elevated and does not react normally to exercise and vasodilators even after successful coarctation surgery.23

A higher immediate success rate than ours has been reported in a recent multi-institutional study on stenting of the native and recurrent coarctation in patients >4 years of age.24 In some centres stents have been used for native coarctation even in newborns and infants25,26 and the introduction of biodegradable stents27 may make the use of stents in small children even more feasible. The use of stents, however, widens the spectrum of possible complications28,29 and the reported complication rate in the multi-institutional study24 was much higher than in our series. It has been shown that neointimal hyperplasia caused by fracture of the internal elastic lamina and the migration of smooth-muscle cells and fibroblasts from tunica media to intima and their proliferation may cause restenosis after balloon angioplasty for aortic coarctation.30 Restenosis in our patients was frequent and an older age at the time of the angioplasty was associated with a higher incidence of reinterventions. Presumably, use of stents in older patients might provide a better long-term outcome. However, stents are even more susceptible to intimal hyperplasia than bare angioplasty30 and long-term results of the recoarctation stenting are yet to be evaluated. In our patients who required reintervention after recoarctation angioplasty, stent implantation provided better results than repeated bare balloon angioplasty. On the other hand, regardless of age, only 7% of recoarctations were resistant to the initial angioplasty and although the probability of reintervention-free survival 20 years after the procedure was only 44%, at 10 years after the procedure it was 70%. Thus in the majority of patients, bare angioplasty may either entirely prevent the need for a stent implantation or at least postpone it to the age when use of adult-sized stents is feasible. Therefore, we advocate balloon angioplasty without use of stents as the initial method of recoarctation treatment for all patients.


   Conclusions
Top
 Abstract
 Introduction
 Patients
 Methods
 Results
 Discussion
 Conclusions
Funding
 Acknowledgements
 References
 
Percutaneous balloon angioplasty of recurrent aortic coarctation without a stent deployment is safe with a low procedural complication rate and incidence of aneurysm formation. Effective widening of the recoarctation diameter is achieved in >90% of patients. Older age at the time of the angioplasty is associated with a higher incidence of reinterventions. The type of surgery and recoarctation anatomy do not influence the outcome. We believe that bare angioplasty should be attempted as the initial treatment in all patients with aortic recoarctation.


   Funding
Top
 Abstract
 Introduction
 Patients
 Methods
 Results
 Discussion
 Conclusions
 Funding
Acknowledgements
 References
 
Internal Grant Agency of the Ministry of Health of the Czech Republic (NR/8422-3).


   Acknowledgements
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 Abstract
 Introduction
 Patients
 Methods
 Results
 Discussion
 Conclusions
 Funding
 Acknowledgements
References
 
We would like to acknowledge Professor Jana Popelová, Na Homolce Hospital, for her care for our adult patients and for her help in obtaining the data.

Conflict of interest: none declared.


   References
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 Introduction
 Patients
 Methods
 Results
 Discussion
 Conclusions
 Funding
 Acknowledgements
 References
 

  1. Sos T, Sniderman KW, Rettek-Sos B, Strupp A, Alonso DR. Percutaneous transluminal dilatation of coarctation of thoracic aorta post mortem. Lancet (1979) 2:970–971.[Web of Science][Medline]
  2. Lock JE, Castaneda-Zuniga WR, Bass JL, Foker JE, Amplatz K, Anderson RW. Balloon dilatation of excised aortic coarctations. Radiology (1982) 143:689–691.[Abstract/Free Full Text]
  3. Lock JE, Niemi T, Burke BA, Einzig S, Castaneda-Zuniga WR. Transcutaneous angioplasty of experimental aortic coarctation. Circulation (1982) 66:1280–1286.[Abstract/Free Full Text]
  4. Singer MI, Rowen M, Dorsey TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J (1982) 103:131–132.[CrossRef][Web of Science][Medline]
  5. Lock JE, Bass JL, Amplatz K, Fuhrman BP, Castaneda-Zuniga W. Balloon dilation angioplasty of aortic coarctations in infants and children. Circulation (1983) 68:109–116.[Abstract/Free Full Text]
  6. Hellenbrand WE, Allen HD, Golinko RJ, Hagler DJ, Lutin W, Kan J. Balloon angioplasty for aortic recoarctation: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol (1990) 65:793–797.[CrossRef][Web of Science][Medline]
  7. McCrindle BW, Jones TK, Morrow WR, Hagler DJ, Lloyd TR, Nouri S, Latson LA. Acute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. J Am Coll Cardiol (1996) 28:1810–1817.[Abstract]
  8. Erbel R, Gorge G, Gerber T, Ge J, Thelen M, Rumpelt HJ, Meyer J. Dissection following balloon angioplasty of aortic coarctation: review of the literature. J Interv Cardiol (1992) 5:99–109.[CrossRef][Web of Science][Medline]
  9. Hijazi ZM, Fahey JT, Kleinman CS, Hellenbrand WE. Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results. Circulation (1991) 84:1150–1156.[Abstract/Free Full Text]
  10. Yetman AT, Nykanen D, McCrindle BW, Sunnegardh J, Adatia I, Freedom RM, Benson L. Balloon angioplasty of recurrent coarctation: a 12-year review. J Am Coll Cardiol (1997) 30:811–816.[Abstract]
  11. Siblini G, Rao PS, Nouri S, Ferdman B, Jureidini SB, Wilson AD. Long-term follow-up results of balloon angioplasty of postoperative aortic recoarctation. Am J Cardiol (1998) 81:61–67.[CrossRef][Web of Science][Medline]
  12. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics (2004) 114(Suppl. 2):555–576.[Free Full Text]
  13. Ralph-Edwards AC, Williams WG, Coles JC, Rebeyka IM, Trusler GA, Freedom RM. Reoperation for recurrent aortic coarctation. Ann Thorac Surg (1995) 60:1303–1307.[Abstract/Free Full Text]
  14. Sakopoulos AG, Hahn TL, Turrentine M, Brown JW. Recurrent aortic coarctation: Is surgical repair still the gold standard? J Thorac Cardiovasc Surg (1998) 116:560–565.[Abstract/Free Full Text]
  15. Lababidi ZA, Daskalopoulos DA, Stoeckle HJ. Transluminal balloon coarctation angioplasty: experience with 27 patients. Am J Cardiol (1984) 54:1288–1291.[CrossRef][Web of Science][Medline]
  16. Rao PS. Transcatheter treatment of pulmonary stenosis and coarctation of the aorta: experience with percutaneous balloon dilatation. Br Heart J (1986) 56:250–258.[Abstract/Free Full Text]
  17. Joyce DH, McGrath LB. Pseudo-aneurysm formation following balloon angioplasty for recurrent coarctation of the aorta. Cathet Cardiovasc Diagn (1990) 20:133–135.[Web of Science][Medline]
  18. Balaji S, Oommen R, Rees PG. Fatal aortic rupture during balloon dilatation of recoarctation. Br Heart J (1991) 65:100–101.[Abstract/Free Full Text]
  19. Rao PS. Fatal aortic rupture during balloon dilatation of recoarctation. Br Heart J (1991) 66:406–407.[Free Full Text]
  20. Roberts DH, Bellamy CM, Ramsdale DR. Fatal aortic rupture during balloon dilatation of recoarctation. Am Heart J (1993) 125:1181–1182.[CrossRef][Web of Science][Medline]
  21. Cooper RS, Ritter SB, Rothe WB, Chen CK, Griepp R, Golinko RJ. Angioplasty for coarctation of the aorta: long-term results. Circulation (1987) 75:600–604.[Abstract/Free Full Text]
  22. Eicken A, Pensl U, Sebening W, Hager A, Genz T, Schreiber C, Lang D, Kaemmerer H, Busch R, Hess J. The fate of systemic blood pressure in patients after effectively stented coarctation. Eur Heart J (2006) 27:1100–1105.[Abstract/Free Full Text]
  23. Samanek M, Goetzova J, Fiserova J, Skovranek J. Differences in muscle blood flow in upper and lower extremities of patients after correction of coarctation of the aorta. Circulation (1976) 54:377–381.[Abstract/Free Full Text]
  24. Forbes TJ, Garekar S, Amin Z, Zahn EM, Nykanen D, Moore P, Qureshi SA, Cheatham JP, Ebeid MR, Hijazi ZM, Sandhu S, Hagler DJ, Sievert H, Fagan TE, Ringewald J, Du W, Tang L, Wax DF, Rhodes J, Johnston TA, Jones TK, Turner DR, Pedra CA, Hellenbrand WE. Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study. Catheter Cardiovasc Interv (2007) 70:276–285.[CrossRef][Web of Science][Medline]
  25. Lee ML. Endovascular stent for the aortic coarctation in a 1.7-kg premie presenting intractable heart failure. Int J Cardiol (2006) 113:236–238.[CrossRef][Web of Science][Medline]
  26. Al-Ata J, Arfi AM, Hussain A, Kouatly A, Galal MO. Stent angioplasty: an effective alternative in selected infants with critical native aortic coarctation. Pediatr Cardiol (2007) 28:183–192.[CrossRef][Web of Science][Medline]
  27. Schranz D, Zartner P, Michel-Behnke I, Akinturk H. Bioabsorbable metal stents for percutaneous treatment of critical recoarctation of the aorta in a newborn. Catheter Cardiovasc Interv (2006) 67:671–673.[CrossRef][Web of Science][Medline]
  28. Varma C, Benson LN, Butany J, McLaughlin PR. Aortic dissection after stent dilatation for coarctation of the aorta: a case report and literature review. Catheter Cardiovasc Interv (2003) 59:528–535.[CrossRef][Web of Science][Medline]
  29. Carrozza M, Santoro G, Giovanna-Russo M, Caianiello G, Calabro R. Stress stent fracture: Is stent angioplasty really a safe therapeutic option in native aortic coarctation? Int J Cardiol (2006) 113:127–128.[CrossRef][Web of Science][Medline]
  30. Ohkubo M, Takahashi K, Kishiro M, Akimoto K, Yamashiro Y. Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation. Pediatr Int (2004) 46:39–47.[CrossRef][Web of Science][Medline]

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