Long-term follow-up results of balloon angioplasty of postoperative aortic recoarctation.

Immediate- and short-term follow-up results of balloon dilatation of aortic recoarctation following surgery have been well documented, but there is sparse data on long-term follow-up. During a 10-year period ending in August 1995, 33 children, aged 2 months to 14 years old, underwent balloon angioplasty of aortic recoarctation. Prior surgery included resection and end-to-end anastomosis (n = 9), subclavian flap (n = 16) or prosthetic (Dacron or Gore-Tex) patch (n = 5) angioplasty, and repair of an interrupted aortic arch (n = 3). Recoarctation developed 1 month to 14 years (mean +/- SD 29 +/- 44 months) after surgery. The indications for angioplasty were peak-to-peak systolic gradients > 20 mm Hg and systemic hypertension and/or congestive heart failure. After balloon angioplasty, the peak-to-peak systolic pressure gradient across the coarctation decreased from 48 +/- 22 to 13 +/- 15 mm Hg (p <0.01), and the size of the coarcted segment increased from 3.3 +/- 1.4 to 6.5 +/- 2.3 mm (p <0.01). Follow-up angiography and/or magnetic resonance imaging were performed in 20 children 17 +/- 12 months after angioplasty. No aneurysms were observed and improvement in the diameter of the coarcted aortic segment (9 +/- 3 mm) persisted. One- to 10-year (median 5) clinical follow-up was available in 32 children. During follow-up, 2 children required surgery to repair a long tubular isthmic narrowing. The residual gradients, determined by arm-leg systolic blood pressure difference, were 5 +/- 8 mm Hg. No patient was symptomatic and only 1 patient (3%) was hypertensive, controlled with antihypertensive medications. We conclude that balloon angioplasty of aortic recoarctation following all types of surgical repair is feasible, safe, and effective with good long-term results. We recommend balloon angioplasty as the procedure of choice in the management of postsurgical recoarctation with hypertension and/or congestive heart failure.

Cardiac disease in children in Lebanon: the AUB-MC Children's Cardiac Registry experience.

OBJECTIVE: To study the epidemiology of cardiac disease in children and their outcome in Lebanon, we established a Children's Cardiac Registry Center (CCRC) at the American University of Beirut-Medical Center. DESIGN/METHODS: The CCRC included prospectively all pediatric patients with congenital heart disease (CHD) and/or acquired heart disease (AHD) who were evaluated at our center, between March 1, 1997 and July 31, 2000. RESULTS: Out of the 1000 patients with cardiac anomalies enrolled in the CCRC, 917 (91.7%) had CHD and the rest had AHD. Ventricular septal defect was the most common cardiac malformation with a relative frequency of 25.3%, followed by pulmonary stenosis (14.6%), aortic anomalies (8%), ASD (8%) and tetralogy of Fallot (7.8%). Complex cardiac lesions like HLHS, TGA and AVC had lower frequencies at 0.4%, 3.7% and 3.5% respectively. The most common AHD was rheumatic heart disease (42.2%). 34.9% of the registry patients with CHD and 10.8% with AHD underwent surgical intervention. There were 4.8% and 2.4% mortality rates in the CHD and AHD groups, respectively during the 40-month study period. CONCLUSION: The prevalence of many of the cardiac malformations in the CCRC was similar to that reported in the literature. However, some of the complex cardiac lesions were less common. The outcome of the two groups of patients is comparable to the outcome of children with cardiac malformation from developed countries. The establishment of a registry at the national level is important. Appropriate identification of the cardiac disease, its epidemiology, and outcome is of utmost importance in guiding adequate care.

Transcatheter management of neonates with pulmonary atresia and intact ventricular septum.

This report describes a 1 day-old infant with valvar pulmonary atresia with intact ventricular septum in whom we were successful in performing transcatheter guidewire perforation and balloon pulmonary valvuloplasty to establish right ventricle-to-pulmonary artery continuity and flow. Also described is implantation of a 4 mm coronary stent into ductus arteriosus in lieu of surgical aortopulmonary shunt to treat pulmonary oligemia and systemic arterial hypoxemia. Details of transcatheter guidewire perforation are presented and it is suggested that this method be used as an alternative to Laser/radio frequency wires, especially in the absence of approval of the latter wires by the regulatory agencies. Stenting of the ductus may be considered an alternative to surgical aortopulmonary shunt. Role of transcatheter technology in the management of selected patients with pulmonary atresia and intact ventricular septum is discussed.