Short- and midterm results of balloon angioplasty for the treatment of coarctation of the aorta in neonates

Amac: Bu calismada aort koarktasyonlu yenidoganlarda balon anjiyoplasti ile ilgili klinik deneyimlerimiz, mevcut verilerimiz ve kisa ve orta donem sonuclarimiz incelendi. Ca­lis­ma­ pla­ni:­Aralik 2004 Mart 2010 tarihleri arasinda aort koarktasyonu nedeniyle balon anjiyoplasti uygulanan 51 yenidogana (41 erkek, 10 kiz; ort. yas 13±9 gun; dagilim 1-30 gun) ait veriler retrospektif olarak incelendi. Bul gu lar: Olgularin 13’unde (%25) izole koarktasyon, 38’inde (%75) kompleks koarktasyon tespit edildi. On sekiz hastada (%35.3) sol ventrikul disfonksiyonu, 17 hastada (%33.3) isthmus hipoplazisi goruldu. En sik eslik eden anomali, ventrikuler septal defekt (VSD) (%49) idi. Yirmi dokuz hastada (%56.9) pulmoner hipertansiyon vardi. Koarktasyon bolgesinde ortalama sistolik basinc gradiyenti dilatasyon oncesi 36±20 mmHg iken, dilatasyon sonrasi 8.6±7.0 mmHg’ye dustu. Bir hastada femoral arter trombozu gelisti. Ortalama izlem suresi 8.7±9.6 ay (dagilim 1-46 ay, ortanca 6 ay) idi. Islem sonrasi ortalama 3.2±3.1 ay sonra 20 hastada (%39.2) rekoarktasyon gelisti. Rekoarktasyon gelisen hastalarin dokuzuna (%45) tekrar anjiyoplasti, 11’ine (%55) cerrahi islem uygulandi. Bir-yedi aylik izlemde yedi hasta (%13.7) kaybedildi. So­nuc:­Kisa ve orta izlem sonuclarina gore balon anjiyoplasti, cerrahi isleme gore yuksek rekoarktasyon oranina sahiptir. Bu nedenle balon anjiyoplasti, kompleks kardiyak hastaligi olan ve genel durumu kotu olan hastalarda tam duzeltme ameliyati yapilana dek sagkalim icin uygulanmalidir. Anah tar soz cuk ler: Aort koarktasyonu; balon anjiyoplasti; yenidogan. Background:­In this study, we reviewed our clinical experience along with the existing data and shortand midterm results of balloon angioplasty for coarctation of aorta in neonates. Methods: The data of 51 neonates (41 boys and 10 girls; mean age 13±9 days; range 1 to 30 days) who underwent balloon angioplasty for aortic coarctation between December 2004 and March 2010 were retrospectively analyzed. Results:­Isolated coarctation was found in 13 patients (25%) and complex coarctation in 38 (75%). The left ventricular dysfunction was seen in 18 patients (35.3%), while 17 patients (33.3%) had isthmus hypoplasia. The most common concomitant abnormality was ventricular septal defect (VSD) (49%). Twenty-nine patients (56.9%) had pulmonary hypertension. The mean systolic pressure gradient across the coarctation site fell from 36±20 mmHg before dilatation to 8.6±7.0 mmHg following the intervention. One patient developed femoral artery thrombosis. The mean follow-up was 8.7±9.6 months (range 1-46, median 6 months). Recoarctation developed in 20 patients (39.2%) after an average 3.2±3.1 months. Of these, nine (45%) with recoarctation underwent repeated angioplasty and 11 (55%) surgical repair. During follow-up of 1-7 months, seven (13.7%) patients died. Conclusion:­ Our shortand midterm results suggest that balloon angioplasty has a higher recoarctation rate than surgery. Therefore, balloon angioplasty should be done to ensure survival until full corrective surgery is performed in patients with complex cardiac disease and poor overall condition.