Balloon angioplasty of native coarctation of the aorta in infants and neonates: is it worth the hassle?

Balloon angioplasty (BA) for native coarctation of the aorta (CA) in infants and neonates remains controversial with a high incidence of restenosis. The purpose of this study is to analyze our acute and midterm results for BA of native CA in infants and neonates and try to identify factors that may be predictive of outcome. Between September 1991 and June 1999, 17 patients with CA underwent BA at a median age of 3 months (range 2 weeks--9 months) and median weight of 4.8 kg (range 2.8--7 kg). Fourteen patients had discrete CA and 3 had tubular hypoplasia. All patients were hemodynamically stable prior to BA and no patients had critical coarctation requiring prostaglandin E(1) infusion to maintain ductus arteriosus patency. Seven patients had other associated cardiac defects. All patients had significant initial improvement. The mean peak systolic gradient across the CA improved from 43 +/- 15 mmHg to 10 +/- 8 mmHg (p < 0.001), and the mean minimum diameter of the aortic lumen increased from 2.4 +/- 0.9 mm to 5.2 +/- 1.0 mm (p < 0.001). There was no mortality or major complication. At median follow-up interval of 2.7 years (0.15-7.75 years), 10 (59%) of 17 patients are clinically well and have an upper to lower limb systolic blood pressure difference of <20 mmHg. Seven (41%) of 17 patients developed significant restenosis (5 of these patients underwent repeat BA, which was successful in 3 patients). Four (24%) patients underwent surgical repair at a median age of 4.5 months (3--6.9 months) and a median time interval of 4 months (2--6.5 months) from the initial BA. All 3 patients with tubular hypoplasia type of CA underwent surgical repair. No patients developed aortic aneurysm following initial or repeat BA. All patients who underwent surgical repair were 1 month or less in age at the time of their initial BA. We conclude that BA of native CA in infants and neonates can be performed safely with low mortality and morbidity. It appears to offer the best results in patients who are older than 1 month with discrete CA and a well-developed aortic arch. Further restenosis of the discrete CA can be managed successfully by repeat BA.

Commotio cordis: cardiovascular manifestations of a rare survivor.

Death due to low-energy chest wall trauma, commotio cordis, may occur in young athletes. Death is sudden and usually refractory to even immediate resuscitation efforts. Herein are described the clinical, angiographic, and hemodynamic data of a rare survivor. These observations suggest that commotio cordis not only may be secondary to ventricular fibrillation, but also may be associated with coronary vasospasm or segmental changes in myocardial contractility.