Stent Implantation for Aortic Coarctation
Background: Optimal timing and mode of treatment for patients with aortic coarctation remains controversial, particularly when the degree of obstruction is mild. Surgery, balloon dilatation, and stent implantation have all proven effective in the treatment of moderate or severe obstruction. In this report, we describe the use of stents to treat coarctation in a heterogeneous population, including patients with relatively mild obstruction.
Methods: Retrospectively, we studied the results of stent implantation in 33 patients, children and young adults, who underwent catheterization for treatment of coarctation. Patients with isolated coarctation, as well as those with associated cardiac defects, were included. The median systolic pressure gradient of our patients was 25 mm Hg.
Results: Patients had an acute decrease in systolic blood pressure gradient (25 mm Hg to 5 mm Hg, P < .001) and an increase in lumen diameter (8 mm to 13 mm, P < .001). When 16 patients were recatheterized during the follow-up period, gradients remained decreased (30 mm Hg to 14 mm Hg, P < .001) compared with prestent values. Ventricular end-diastolic pressure, which was increased in 82% of patients at the time of initial catheterization, decreased from 17 mm Hg to 14 mm Hg (P = .002). Although the procedure was generally safe, serious complications did occur.
Conclusions: Stent implantation represents a therapeutic option that can safely and effectively reduce gradient in challenging patients with mild postoperative coarctation. Furthermore, our data suggest that aortic obstruction often coexists with ventricular diastolic dysfunction in these patients and that relief of obstruction may play a role in improvement of function.
The optimal management of residual or recurrent coarctation in children and young adults remains unclear, particularly when the degree of obstruction is mild. Physicians make decisions to intervene based on factors such as arm-leg blood pressure gradients, systemic hypertension, or rarely, symptoms. Historically, therapeutic options have included medical antihypertensive therapy, balloon dilatation angioplasty, and surgery. More recently, our institution and others have reported safe and effective short-term treatment of coarctation with implantation of balloon-expandable stents. Follow-up data remain scant; one prior series contains data from invasive reassessment of patients with severe coarctation. We report the acute effect and medium-term follow-up of aortic stent implantation within a heterogeneous population of children and young adults with predominantly mild residual or recurrent coarctation. Half of the patients who underwent successful stent implantation returned for invasive reassessment during the follow-up period. Although we focused primarily on the patients' systolic blood pressure gradient measured at follow-up, we secondarily observed a decrease in the ventricular end-diastolic pressure at the time of reevaluation.
Background: Optimal timing and mode of treatment for patients with aortic coarctation remains controversial, particularly when the degree of obstruction is mild. Surgery, balloon dilatation, and stent implantation have all proven effective in the treatment of moderate or severe obstruction. In this report, we describe the use of stents to treat coarctation in a heterogeneous population, including patients with relatively mild obstruction.
Methods: Retrospectively, we studied the results of stent implantation in 33 patients, children and young adults, who underwent catheterization for treatment of coarctation. Patients with isolated coarctation, as well as those with associated cardiac defects, were included. The median systolic pressure gradient of our patients was 25 mm Hg.
Results: Patients had an acute decrease in systolic blood pressure gradient (25 mm Hg to 5 mm Hg, P < .001) and an increase in lumen diameter (8 mm to 13 mm, P < .001). When 16 patients were recatheterized during the follow-up period, gradients remained decreased (30 mm Hg to 14 mm Hg, P < .001) compared with prestent values. Ventricular end-diastolic pressure, which was increased in 82% of patients at the time of initial catheterization, decreased from 17 mm Hg to 14 mm Hg (P = .002). Although the procedure was generally safe, serious complications did occur.
Conclusions: Stent implantation represents a therapeutic option that can safely and effectively reduce gradient in challenging patients with mild postoperative coarctation. Furthermore, our data suggest that aortic obstruction often coexists with ventricular diastolic dysfunction in these patients and that relief of obstruction may play a role in improvement of function.
The optimal management of residual or recurrent coarctation in children and young adults remains unclear, particularly when the degree of obstruction is mild. Physicians make decisions to intervene based on factors such as arm-leg blood pressure gradients, systemic hypertension, or rarely, symptoms. Historically, therapeutic options have included medical antihypertensive therapy, balloon dilatation angioplasty, and surgery. More recently, our institution and others have reported safe and effective short-term treatment of coarctation with implantation of balloon-expandable stents. Follow-up data remain scant; one prior series contains data from invasive reassessment of patients with severe coarctation. We report the acute effect and medium-term follow-up of aortic stent implantation within a heterogeneous population of children and young adults with predominantly mild residual or recurrent coarctation. Half of the patients who underwent successful stent implantation returned for invasive reassessment during the follow-up period. Although we focused primarily on the patients' systolic blood pressure gradient measured at follow-up, we secondarily observed a decrease in the ventricular end-diastolic pressure at the time of reevaluation.
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