Original Research Articles
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Journal of Structural Heart Disease, August 2016, Volume 2, Issue 4:91-97
DOI: 10.12945/j.jshd.2016.005.15
Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?
Shehla Jadoon, MRCPCH1, Milad El-Segaier, MD, PhD1,2, Mohammed Omar Galal, MD, PhD, MBA3,4*
1 Department of Pediatric Cardiology, King Fahad Medical City, King Salman Heart Center, Riyadh, Saudi Arabia
2 Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
3 Department of Pediatric Cardiology, Essen University, Essen, Germany
4 Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
Abstract
Background: Coarctation of aorta may present as severe heart failure in infants and may lead to myocardial dysfunction. Current evidence supports surgical management of neonatal coarctation; however, it can be precarious in sick infants. Thus, percutaneous balloon angioplasty may be a beneficial alternative palliation before possible surgical treatment.
Methods: To investigate the safety, efficacy, immediate, and mid-term outcome of percutaneous balloon angioplasty for aortic coarctation in infants who present late and have additional risk factors for surgical treatment, a retrospective case series was examined, reviewing the charts of all patients under six months of age who underwent balloon angioplasty for aortic coarctation.
Results: Between January 2008 and April 2014, 14 infants with coarctation were included. Their mean weight was 3.5 kg (1.9–5 kg) and they had a mean age of 69 days (4–142 days). All patients were sick, needed admission in an intensive care unit for inotropic and/or ventilator support, and had different additional risk factors for surgery. All underwent successful percutaneous balloon angioplasty with minor complications. Following which their clinical condition and left ventricular function improved leading to weaning from inotrope and ventilator support. On further follow up, seven underwent elective surgical repair, two needed re-dilation, and three continued without any further intervention.
Conclusions: Surgical repair for native neonatal and infantile coarctation is a preferred choice of treatment, but it can be challenging in sick patients with additional risk factors. However, percutaneous balloon angioplasty remains a safe and effective temporary palliation. Despite a high incidence of restenosis, some patients do not need mid-term further intervention.
Cite this article as: Jadoon S, El-Segaier M, Galal MO. Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?. Structural Heart Disease 2016;2(4):91-97. DOI: 10.12945/j.jshd.2016.005.15
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Original Research Articles
Journal of Structural Heart Disease, August 2016, Volume 2, Issue 4:91-97
DOI: 10.12945/j.jshd.2016.005.15
Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?
Shehla Jadoon, MRCPCH1, Milad El-Segaier, MD, PhD1,2, Mohammed Omar Galal, MD, PhD, MBA3,4*
1 Department of Pediatric Cardiology, King Fahad Medical City, King Salman Heart Center, Riyadh, Saudi Arabia
2 Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
3 Department of Pediatric Cardiology, Essen University, Essen, Germany
4 Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
Abstract
Background: Coarctation of aorta may present as severe heart failure in infants and may lead to myocardial dysfunction. Current evidence supports surgical management of neonatal coarctation; however, it can be precarious in sick infants. Thus, percutaneous balloon angioplasty may be a beneficial alternative palliation before possible surgical treatment.
Methods: To investigate the safety, efficacy, immediate, and mid-term outcome of percutaneous balloon angioplasty for aortic coarctation in infants who present late and have additional risk factors for surgical treatment, a retrospective case series was examined, reviewing the charts of all patients under six months of age who underwent balloon angioplasty for aortic coarctation.
Results: Between January 2008 and April 2014, 14 infants with coarctation were included. Their mean weight was 3.5 kg (1.9–5 kg) and they had a mean age of 69 days (4–142 days). All patients were sick, needed admission in an intensive care unit for inotropic and/or ventilator support, and had different additional risk factors for surgery. All underwent successful percutaneous balloon angioplasty with minor complications. Following which their clinical condition and left ventricular function improved leading to weaning from inotrope and ventilator support. On further follow up, seven underwent elective surgical repair, two needed re-dilation, and three continued without any further intervention.
Conclusions: Surgical repair for native neonatal and infantile coarctation is a preferred choice of treatment, but it can be challenging in sick patients with additional risk factors. However, percutaneous balloon angioplasty remains a safe and effective temporary palliation. Despite a high incidence of restenosis, some patients do not need mid-term further intervention.
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Cite this article as: Jadoon S, El-Segaier M, Galal MO. Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?. Structural Heart Disease 2016;2(4):91-97. DOI: 10.12945/j.jshd.2016.005.15
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