Cutting Balloon Angioplasty for Aortic Coarctation

Background. Cutting balloon angioplasty (CBA) has improved outcomes for resistant stenotic vascular lesions in adult coronary artery disease. Application of this technique in coarctation of the aorta (CoA) in children has not been reported. Objective. We sought to review the safety, efficacy and outcomes of CBA in the setting of CoA. Methods and Results. Between February 2004 and October 2007,8 children (4 males) underwent 10 procedures. The median age was 5.5 months (range: 2.5 months to 5 years) and median weight 7.5 kg (range: 4.1-13.3 kg). Two children had native CoA. CBA was employed due to a persistent waist after conventional balloon angioplasty (6 procedures) or as the primary dilatation (4 procedures). The cutting balloon diameter was a median 143% (range: 108-222%) of the diameter of the lesion. After dilatation, all children underwent further conventional balloon angioplasty. The CoA median diameter increased from 2.8 mm (range: 1.8-4 mm) to 4 mm (range: 2.9-6.7 mm; p = 0.0018), and the arm-to-leg blood systolic blood pressure gradient decreased from 38.5 mmHg (range: 2-70 mmHg) to 7 mmHg (0-30 mmHg; p < 0.0001). The median follow-up period was 4.6 months (range: 0.5-15.6 months), and 2 children required a second balloon dilatation. No aneurysm formation was observed acutely, although 2 children each developed a femoral arteriovenous fistula or a pseudoaneurysm. Conclusion. This early experience suggests that CBA is acutely safe and can be effective in the management of recalcitrant coarctation lesions in the young.