Objective:Surgical repair or stenting has been the standard treatment for patients with discrete near-total or total occlusion of aortic CoArctation (CoA) in both adolescents and adults. The role of plain Balloon Angioplasty (BA) as definitive therapy has not been well established in these patients due to the reported higher rates of complication and re-coarctation. The purpose was to evaluate intermediate-term outcome following BA of such patients by using different techniques in those patients where surgery or stenting was not possible.
Materials and Methods:The data of 9 patients of such CoA treated with BA from January 2014 to December 2018 was analyzed. The approach for BA was retrograde in 4 patients and antegrade in 5 patients. Different stiff coronary hardware was used in some cases to cross the occluded segments and make the procedure successful. They were evaluated at a mean interval of 43 months (range 14-72 months). The assessment included clinical examination, echocardiography and cardiac catheterization as and when required.
Results:The mean age of studied patients was 27.88 year (range 14–52 years). Immediate success was obtained in all patients with no early mortality or major complications. Peak systolic pressure gradient reduced from 79.11±19mmHg to10.89 ±7.11mmHg immediately. On follow-up, out of the 5 patients who had Doppler peak gradient of more than 20 mmHg, none had significant peak systolic gradient on catheterization. There was no mortality or serious complications on follow-up. Hypertension was completely relieved in 45% (4/9) and improved in 55% (5/9)patients.
Conclusion:Balloon angioplasty of discrete near-total or total occlusion of native CoA by different method is safe and effective on the intermediate follow- up and can be considered in patients who are not candidates for surgery or stenting.
Kakasaheb H Bhosale*, Ranjit Kumar Nath