Heart Center: Aortic Balloon Angioplasty

Coarctation of the aorta is a narrowing of the aorta, the blood vessel that carries blood to the body. It usually involves an isolated area of the aorta and occurs in five to 8 percent of all patients with congenital heart disease, or 0.04 percent of the general population. The severity is determined by the pressure difference, or gradient, measured between the aorta above and below the narrowing. The greater the pressure difference, the more severe the coarctation. If the pressure difference is greater than 20mmHg, if the patient has congestive heart failure, or if the patient has high blood pressure, intervention is necessary.

In the past, surgeons were asked to repair this defect by cutting out the narrow segment and sewing the aorta back together. Today a non-surgical technique called aortic balloon angioplasty can be used to correct the coarctation. During this procedure, a catheter with a balloon on the end is advanced under fluoroscopy (X-ray) across the narrowed area from an artery in the leg. Once the catheter is in place, the balloon is rapidly inflated and deflated to dilate, or open, the narrowed area. This technique can be performed successfully on patients who have, and patients who have not, had prior surgery, but it is most often performed on patients who have developed a recurrence of the coarctation. After the procedure, the patient is admitted to the hospital for overnight observation and released the next morning.

Results from a balloon angioplasty of a coarctation vary with age, severity of high blood pressure before the procedure, and type of coarctation (recurrent vs. coarctation that has never been repaired, or native). In general, the immediate success rate for native coarctations of all age groups is 81-91%, and the success rate for recurrent coarctations is 75-82 percent. Recurrences of the coarctation can occur after the angioplasty, but there is no significant difference in patients older than 1 year of age as compared to surgery. The risk for death is 1 percent or less with angioplasty and is usually related to other associated cardiac lesions, not the procedure itself.

A few complications can occur with this procedure: femoral artery damage, aortic aneurysm (bulging in a weak spot), bleeding, increased X-ray exposure time, and death. To combat these complications, the balloon size is carefully matched to the size of the aorta above and below the narrowing, and heparin, a blood thinner, is given to prevent blood clot formation. Blood is ordered and is available for immediate use in case of bleeding. A cardiac surgeon is available if a significant complication occurs during the procedure.

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