Balloon arterioplasty of recurrent coarctation after the modified Norwood procedure in infants

Wayne Tworetzky, Doff B. McElhinney, Grant Burch, David F. Teitel, Phillip Moore

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Coarctation of the reconstructed aorta after the modified Norwood procedure for hypoplastic left heart syndrome is a relatively common occurrence that can have significant adverse effects. From 1992-98, 65 infants with hypoplastic left heart syndrome or variants thereof underwent a modified Norwood procedure. Of the 50 survivors of Stage I palliation, 10 (20%) were subsequently diagnosed with clinically significant obstruction of the aortic arch at a median age of 5.1 months. Eight of these patients underwent coarctation balloon arterioplasty. All 8 patients underwent successful dilation of the coarctation, with a decrease in the pressure gradient from 43 ± 20 to 4 ± 5 mmHg and an increase in aortic diameter at the site of obstruction from 3.5 ± 0.5 to 7.0 ± 1.0 mm (both P <0.001). There was also a significant increase in lower extremity systolic blood pressure. Although there was no immediate increase in cardiac output after dilation in most patients, ventricular function was improved in 3 patients within 24-48 hr of the procedure and in all but 2 at the most recent follow- up (median 2 years). Two patients developed bradycardia during wire placement that required cardiopulmonary resuscitation. Two others died suddenly during the follow-up period. All surviving patients have undergone subsequent palliative procedures; none have required repeat intervention for arch obstruction. We found a 20% incidence of coarctation in survivors of the modified Norwood procedure. Balloon arterioplasty is effective in relieving this obstruction, and should be carried out promptly upon diagnosis to minimize its deleterious effects on ventricular function. Balloon dilation, however, should be considered a high-risk procedure in these fragile infants, and special attention must be given to cardiovascular support. (C) 2000 Wiley-Liss, Inc.

Original languageEnglish (US)
Pages (from-to)54-58
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume50
Issue number1
StatePublished - 2000
Externally publishedYes

Fingerprint

Norwood Procedures
Hypoplastic Left Heart Syndrome
Dilatation
Ventricular Function
Survivors
Blood Pressure
Aortic Coarctation
Cardiopulmonary Resuscitation
Bradycardia
Thoracic Aorta
Cardiac Output
Lower Extremity
Pressure
Incidence

Keywords

  • Balloon arterioplasty
  • Coarctation
  • Norwood

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Balloon arterioplasty of recurrent coarctation after the modified Norwood procedure in infants. / Tworetzky, Wayne; McElhinney, Doff B.; Burch, Grant; Teitel, David F.; Moore, Phillip.

In: Catheterization and Cardiovascular Interventions, Vol. 50, No. 1, 2000, p. 54-58.

Research output: Contribution to journalArticle

Tworetzky, Wayne ; McElhinney, Doff B. ; Burch, Grant ; Teitel, David F. ; Moore, Phillip. / Balloon arterioplasty of recurrent coarctation after the modified Norwood procedure in infants. In: Catheterization and Cardiovascular Interventions. 2000 ; Vol. 50, No. 1. pp. 54-58.
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