[Percutaneous angioplasty of aortic recoarctation: short- and mid-term results in 18 cases]. / Angioplastie percutanée de recoarctation de l'aorte: résultats dans 18 cas à court et moyen terme.

ABSTRACT

Between January 1986 and July 1992, 18 percutaneous angioplasties were performed in 18 consecutive patients with recoarctation of the aorta, who were aged 2 months to 29 years. Fifteen had been operated for coarctation of the aorta and 3 for interruption of the aortic arch. The diameter of the dilating balloon was the same, to 1 mm, as that of the healthy aorta, usually measured just proximal to the stenosis. There were 3 femoral artery thromboses; one small aneurysm which did not increase in size, and 1 hypertensive crisis in a child. The diameter of the stenosis increased by 42.39 +/- 34.24%, the gradient decreased from 41.39 +/- 14.58 mmHg to 23.7 +/- 16.30 mmHg and the Doppler gradient from 57.89 +/- 15.29 mmHg to 36.55 +/- 16.50 mmHg. Eight angioplasties, including 5 of the last 7 procedures, were considered primary successes by 2 criteria increase of the diameter of the stenosis by at least 40% and a residual catheter gradient of less than 20 mmHg. The best results were obtained in severe, localised central stenoses. Sixteen patients were followed up for 2 to 69 months. Two were operated after failed angioplasty, without complications. No late aneurysms or restenoses were observed in the cases successfully dilated followed up clinically (7), by MRI (5) or catheterisation (2). In one case, aortography showed remodelling with normalisation of the aortic arch after 24 months. These results indicate that percutaneous angioplasty is a simple method of treating recoarctation of the aorta, which is most effective in severe stenoses the immediate risk is low. The late risks of recoarctation and aneurysm justify systematic follow-up.