Aim
: To define the long-term effect of balloon angioplasty (BA) of aortic coarctation (AC) on systemic hypertension and left ventricular hypertrophy (LVH) in adolescent and adult patients.
Methods
: Follow-up data of 53 patients (mean age 24 ± 9 years) undergoing BA for discrete AC at median interval of 12.5 years (range 5–19 years) including cardiac catheterization, MRI and Echocardiography form the basis of this study. Patients were divided into two groups (A&B) based on whether or not long-term antihypertensive therapy was required.
Results
: No early or late deaths occurred. Fifty-one patients had baseline hypertension, 49 patients had baseline LVH (92%), BA produced an immediate reduction in peak AC gradient from 66 ± 23 mmHg (95% confidence interval [CI]: 59.5 to 72.7) to 10.8 ± 7 mmHg (95% CI: 8.8 to 12.5) (p< 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 ± 6 mmHg (95% CI: 4.4 to 7.9) (p<0.001). The Doppler gradient across coarctation decreased from 59.6 ± 17 to 16 ± 8.4 mmHg at one year and 12.0 ± 6.9 mmHg at last follow-up. Left ventricular mass index (LVMI) decreased significantly in 48 patients (98%) from 132 ± 30.7 (95% CI: 122 to 141.9) to 86 ± 19.9 gram/m
2
(95% CI: 79.5 to 92.5)(p<0.0001). The systolic blood pressure decreased from 165 ± 17 mmHg (95% CI: 159 to 171) to 125 ± 10 mmHg (95% CI: 122 to 131, p<0.001) in 40 patients (group A) and from 184 ± 19 mmHg (95% CI: 169 to 198) to 142 ± 22 mmHg (95% CI: 124 to 156, p<0.001) in 11 patients (group B). The blood pressure had normalized without medication in 40 (78%) of the 51 patients (165 ± 17 mmHg to 115 ± 10 mmHg).
Conclusion
:
Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease;
Regression of LVH (≥ 20% reduction in LVMI) occurred in 98% of patients after BA and only 22% of patients required medications for hypertension.
Long-term results (up to 18 years) of balloon angioplasty on systemic hypertension in adolescent and adult patients with coarctation of the aorta