Transcatheter treatment for native aortic coarctation in adult

الملخص EN

Objectives : We sought to investigate the result of transcatheter treatment for native aortic coarctation in adult and compare the success rate and early complication rate between balloon angioplasty and self expandable stent.

Background : Surgical repair was considered the conventional treatment for native aortic coarctation while balloon angioplasty emerged recently as an alternative to surgical repair and considered the treatment of choice in recurrent postoperative coarctation but its use with or without endovascular stent implantation for native coarctation remains controversial.

Method : Fifty one patients with native coarctation underwent transcatheter intervention in two different cardiac centers in Baghdad between January 2001 and July 2004, 26 patients underwent balloon angioplasty alone while 25 patients had endovascular stenting for coarctation.

Hemodynamic, angiographic and follow up data were reviewed and analyzed for each patient.

Result: The procedure acutely reduced the transcoarctation systolic pressure gradient from 68±23 to 7.5±11 mmHg with increase in minimal luminal diameter of coarct segment more than two folds post intervention .

The immediate success rate was comparable in stent and balloon group 88% versus 84 % respectively.

Nearly half of our patients become normotensive without antihypertensive medication before discharge.

Minor complications found to be significantly higher among balloon group as compared to stent group 34% versus 28%.On six months follow up two patients in balloon group had significant increment in pressure gradient while those who underwent stent implantation only one patient had reintervention because of suboptimal initial result.

Conclusion : balloon angioplasty with or without endovascular stenting is safe and effective nonsurgical approach for native aortic coarctation in adult.

Large sample size and longer follow up is recommended to confirm this result.