Balloon Angioplasty in the Treatment of Children with Native Aortic Coarctation: Is Reintervention Predictable?
Abstract
Background/Aim: Reintervention after balloon angioplasty is often considered inevitable in children with coarctation of the aorta (COA). The present study aimed to evaluate predictors of re-intervention after balloon angioplasty for coarctation of the aorta, with the goal of identifying patient and procedural characteristics that may influence long-term outcomes.
Methods: A retrospective study involved children who underwent balloon angioplasty for coarctation of the aorta at a specialised interventional cardiovascular centre over a period of four years. A two set of data were collected: first, the clinical-demographical data (age, sex, weight, associated congenital heart disease, syndromic features). Second, a procedure related data (type of anaesthesia, heparin use, type and number of balloons used, fluoroscopy duration, procedure outcome and complications). Early interventional success is considered if the peak systolic pressure gradient (PG) achieves less than 20 mm Hg. All patients were followed for 12 months during which the pressure gradient was measured periodically by echocardiography and any reintervention was documented.
Results: A total of 37 children underwent balloon angioplasty during the study period. Most children (62.2 %) underwent the procedure after the first year of life. The procedure was successful early in 35 (95 %) of cases. On follow-up for 12 months, 8 patients (22 %) needed re-intervention. Eight factors were identified as significantly associated with the likelihood of re-intervention, including younger age, lower ejection fraction, use of two balloons, procedural complications, longer duration, smaller COA size, higher residual pressure gradient and a lower reduction in the peak systolic PG.
Conclusion: This study emphasised the multifactorial nature of re-intervention risk following balloon angioplasty for COA. Careful consideration of patient age, ventricular function, anatomical characteristics, procedural complexity and immediate haemodynamic results is essential to decrease the need for reintervention.
References
Islam SS, Yasmin F, Rima R, Ahmed AUA, Selim MR. Coarctation of the aorta in infants: a diagnostic challenge. Ibrahim Cardiac Med J 2023;12(2):21-6. doi: 10.3329/icmj.v12i2.69855.
Backer CL, Dearani JA, Mavroudis C. Coarctation of the aorta. In: Mavroudis C, Backer CL, Eds. Pediatric cardiac surgery. Hoboken, NJ: Wiley; 2023; pp. 249–277; doi: 10.1002/9781119282327.ch13.
National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143-421. PMID: 12485966.
Raza S, Aggarwal S, Jenkins P, Kharabish A, Anwer S, Cullington D, et al. Coarctation of the aorta: diagnosis and management. Diagnostics (Basel). 2023 Jun 27;13(13):2189. doi: 10.3390/diagnostics13132189.
Stephens EH, Feins EN, Karamlou T, Anderson BR, Alsoufi B, Bleiweis MS, et al. The Society of Thoracic Surgeons clinical practice guidelines on the management of neonates and infants with coarctation. Ann Thorac Surg. 2024 Sep;118(3):527-44. doi: 10.1016/j.athoracsur.2024.04.012.
Rao PS. Balloon angioplasty of aortic coarctation: a review. Clin Cardiol. 1989 Nov;12(11):618-28. doi: 10.1002/clc.4960121103.
Rao PS. Balloon dilatation in the management of congenital obstructive lesions of the heart: review of author's experiences and observations-Part II. J Cardiovasc Dev Dis. 2023 Jul 6;10(7):288. doi: 10.3390/jcdd10070288.
Satsangi A. An insight into interventions after previous coarctation of aorta repair. Open Access J Cardiol 2021;5(1); doi: 10.23880/oajc-16000164.
Sandoval JP, Kang SL, Lee KJ, Benson L, Asoh K, Chaturvedi RR. Balloon angioplasty for native aortic coarctation in 3- to 12-month-old infants. Circ Cardiovasc Interv. 2020 Nov;13(11):e008938. doi: 10.1161/CIRCINTERVENTIONS.120.008938.
Yaseen M, Akram N, Nori W. Intravascular foreign bodies retrieval: Navigating differences from childhood to adulthood. Scr Med 2025;56(1):69–76; doi: 10.5937/scriptamed56-53482.
Yaseen MJ, Neamaa EK, Haji GF. Assessment of high risk pregnant women by fetal echocardiography. Al-Rafidain J Med Sci. 2024;7(2):157–62. doi: 10.54133/ajms.v7i2.1476.
Holzer RJ, Gauvreau K, McEnaney K, Watanabe H, Ringel R. Long-term outcomes of the coarctation of the aorta stent trials. Circ Cardiovasc Interv. 2021 Jun;14(6):e010308. doi: 10.1161/CIRCINTERVENTIONS.120.010308.
Ino T, Ohkubo M. Dilation mechanism, causes of restenosis and stenting in balloon coarctation angioplasty. Acta Paediatrica, Int J Paediatrics 1997;86(4):367–71. doi: 10.1111/j.1651-2227.1997.tb09024.x.
Abdulqader S, Bakr GM, Ahmed SA, Hassan QH, Al-Kinani. Gender distribution of coronary artery calcium score and degree of stenosis assessed by computed tomography angiography in iraqi patients with chest pain. Al-Rafidain J Med Sci. 2024;7(1):78–84. doi: 10.54133/ajms.v7i1.1032.
Rao PS, Chopra PS. Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg. 1991 Sep;52(3):621-31. doi: 10.1016/0003-4975(91)90961-o.
Patel HT, Madani A, Paris YM, Warner KG, Hijazi ZM. Balloon angioplasty of native coarctation of the aorta in infants and neonates: is it worth the hassle? Pediatr Cardiol. 2001 Jan-Feb;22(1):53-7. doi: 10.1007/s002460010153.
Alaei F, Moghadam MY, Mortaezaian H, Alaei M, Bakhshandeh H. Balloon Angioplasty versus Surgical Repair of Coarctation of Aorta in Infants. J Tehran Heart Cent. 2011 Summer;6(3):134-7. Epub 2011 Aug 31. PMID: 23074619.
D'Souza VJ, Velasquez G, Weesner KM, Prabhu S. Transluminal angioplasty of aortic coarctation with a two-balloon technique. Am J Cardiol. 1984 Aug 1;54(3):457-8. doi: 10.1016/0002-9149(84)90224-8.
Moore JW, Pearson CE, Lee DH, Raybuck B. Dual-balloon angioplasty of recoarctation of the aorta. Tex Heart Inst J. 1987 Mar;14(1):102-5. PMID: 15227338.
Midei MG, Brennan M, Walford GD, Aversano T, Gottlieb SO, Brinker JA. Double vs single balloon technique for aortic balloon valvuloplasty. Chest. 1988 Aug;94(2):245-50. doi: 10.1378/chest.94.2.245.
Bello Valls ML, Salih HG, El Dadah OM, Alghamdi AA, Alhabshan F, Ismail SR, et al. Cardiac recovery and outcome of neonates and infants presenting with severe aortic coarctation and depressed cardiac function. Egypt Heart J. 2018 Dec;70(4):255-60. doi: 10.1016/j.ehj.2018.04.010.
Florianczyk T, Werner B. Assessment of left ventricular systolic function using tissue Doppler imaging in children after successful repair of aortic coarctation. Clin Physiol Funct Imaging. 2010 Jan;30(1):1-5. doi: 10.1111/j.1475-097X.2009.00894.x.
Florianczyk T, Werner B. Assessment of left ventricular diastolic function in children after successful repair of aortic coarctation. Clin Res Cardiol. 2011 Jun;100(6):493-9. doi: 10.1007/s00392-010-0272-1.
Walhout RJ, Suttorp MJ, Mackaij GJ, Ernst JM, Plokker HW. Long-term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue? Catheter Cardiovasc Interv. 2009 Mar 1;73(4):549-56. doi: 10.1002/ccd.21842.
Ylinen MK, Pihkala JI, Salminen JT, Sarkola T. Predictors of blood pressure and hypertension long-term after treatment of isolated coarctation of the aorta in children-a population-based study. Interact Cardiovasc Thorac Surg. 2022 Aug 3;35(3):ivac212. doi: 10.1093/icvts/ivac212.
Meidell Blylod V, Rinnström D, Pennlert J, Ostenfeld E, Dellborg M, Sörensson P, e al. Interventions in adults with repaired coarctation of the aorta. J Am Heart Assoc. 2022 Jul 19;11(14):e023954. doi: 10.1161/JAHA.121.023954.
Suradi H, Hijazi ZM. Current management of coarctation of the aorta. Glob Cardiol Sci Pract. 2015 Nov 18;2015(4):44. doi: 10.5339/gcsp.2015.44.
Hussein MR, Abed NY, Abed MY, Akram NN. Outcome comparison between transcatheter closure and surgical closure of atrial septum defect. Acta Marisiensis-Seria Medica. 2025 May 30;71(2);doi: 10.2478/amma-2025-0023.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).