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Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation

Published online by Cambridge University Press:  01 July 2011

Jarupim Soongswang ,
Brian W. McCrindle ,
Thomas K. Jones ,
Robert N. Vincent ,
Daphne T. Hsu ,
Michael A. Kuhn ,
William B. Moskowitz ,
John R. Cheatham ,
Dipak H. Kholwadwala  and
Lee N. Benson
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Jarupim Soongswang
Affiliation:
Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Brian W. McCrindle*
Affiliation:
Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Thomas K. Jones
Affiliation:
Department of Pediatrics, Children's Hospital and Medical Center, Seattle, WA
Robert N. Vincent
Affiliation:
Department of Pediatrics, Children's Heart Center, Atlanta, GA
Daphne T. Hsu
Affiliation:
Division of Pediatric Cardiology, Columbia Presbyterian Medical Center, Babies & Children Hospital, New York, NY
Michael A. Kuhn
Affiliation:
Section of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, CA
William B. Moskowitz
Affiliation:
Division of Pediatric Cardiology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VI
John R. Cheatham
Affiliation:
Joint Division of Pediatric Cardiology, University of Nebraska and Creighton University, Omaha, NA
Dipak H. Kholwadwala
Affiliation:
North Shore University Hospital, Cornell University Medical College, New York, NY, USA
Lee N. Benson
Affiliation:
Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
David G. Nykanen
Affiliation:
Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
*
Correspondence to: Brian W. McCrindle, Division of Cardiology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel: 416 813 7610; Fax: 416 813 7547; E-mail: brian.mccrindle@sickkids.on.ca
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Abstract

Obstruction of the reconstructed aortic arch, or the neoaortic arch, is now known to be an important factor increasing mortality after the Norwood operation for hypoplastic left heart syndrome. Transcatheter balloon angioplasty has been shown to provide effective relief of both native aortic coarctation and obstructions of the aortic arch occurring subsequent to therapeutic intervention. We sought to determine the outcomes of balloon angioplasty used as an initial treatment for obstruction of the neoaortic arch occurring after the Norwood operation. We gathered the characteristics of 58 patients with such obstruction from 8 institutions, noting procedural factors and outcomes of initial balloon dilation. Obstruction occurred at a median interval of 4 months, with a range from 1.5 months to 6.3 years, after a Norwood operation. Ventricular dysfunction was present before dilation in 13 patients. Mean peak to peak systolic pressure gradients were acutely reduced from 31±20 mm Hg to 6±9 mmHg (p<0.001), with outcome subjectively judged to be successful in 89%- Three patients with pre-existing ventricular dysfunction died within 48 hours of dilation. There were 10 additional deaths during the period of followup, with Kaplan Meier estimates of survival after intervention of 87% at 1 month, 77% at 12 months, and 72% after 15 months. In addition, 9 patients required re-intervention during the period of follow-up, with Kaplan Meier estimates of freedom from re-intervention after dilation of 87% at 6 months, 78% at 12 months and 74% after 18 months. Although transcatheter dilation of neoaortic arch obstructions after Norwood operation is successful, there is a high risk of re-intervention and ongoing mortality in this subgroup of patients. Close follow-up is recommended.

Keywords

Aortic arch obstructionhypoplastic left heart syndromeballoon angioplastyNorwood operation
Type
Original Articles
Information
Cardiology in the Young , Volume 11 , Issue 1 , January 2001 , pp. 54 - 61
Copyright
Copyright © Cambridge University Press 2001

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