Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-12T22:09:58.331Z Has data issue: false hasContentIssue false

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
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: [email protected]

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fyler, DC. Report of the New England Regional Infant Cardiac Program. Pediatrics 1980;65:376461.Google Scholar
2.Morris, CD, Outcalt, J, Menashe, VD. Hypoplastic left heart syndrome: natural history in a geographically defined population. Pediatrics 1990;85:977983.CrossRefGoogle Scholar
3.Norwood, WI, Lang, P, Castaneda, AR, Campbell, DN. Experience with operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1981;82:511519.CrossRefGoogle ScholarPubMed
4.Iannettoni, MD, Bove, EL, Mosca, RS et al. , Improving results with first-stage palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1994;107:934940.CrossRefGoogle ScholarPubMed
5.Bando, K, Turrentine, MW, Sun, K et al. , Surgical management of hypoplastic left heart syndrome. Ann Thorac Surg 1996;62:7077.CrossRefGoogle ScholarPubMed
6.Murdison, KA, Baffa, JM, Farrel, PE Jr. et al. , Hypoplastic left heart syndrome: outcome after initial reconstruction and before modified Fontan procedure. Circulation 1990;82:IV199.Google ScholarPubMed
7.Jonas, RA. Intermediate procedures after first-stage Norwood operation facilitate subsequent repair. Ann Thorac Surg 1991;52:696700.CrossRefGoogle ScholarPubMed
8.Meliones, JN, Snider, AR, Bove, EL, Rosenthal, A, Rosen, DA. Longitudinal results after first-stage palliation fot hypoplastic left heart syndrome. Circulation 1990;82:4151.Google Scholar
9.Weinberg, PM, Chin, AJ, Murphy, JD, Pigott, JD, Norwood, WI. Postmortem echocardiography and tomographic anatomy of hypoplastic left heart syndrome after palliative surgery. Am J Cardiol 1986;58:12281232.CrossRefGoogle ScholarPubMed
10.Zellers, TM. Balloon angioplasty for recurrent coarctation of the aorta in patients following staged palliation for hypoplastic left heart syndrome. Am J Cardiol 1999;84:231233.CrossRefGoogle ScholarPubMed
11.Yetman, AT, Nykanen, D, McCrindle, BW et al. , Balloon angioplasty of recurrent coarctation: A 12-year review. J Am Coll Cardiol 1997;30:811816.CrossRefGoogle ScholarPubMed
12.Saul, JP, Keane, JF, Fellows, KE, Lock, JE. Balloon dilation angioplasty of postoperative aortic obstructions. Am J Cardiol 1987;59:943948.CrossRefGoogle ScholarPubMed
13.McCrindle, BW, Jones, TK, Morrow, WR et al. , Acute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. J Am Coll Cardiol 1996;28:18101817.CrossRefGoogle ScholarPubMed
14.Jacobs, ML, Rychik, J, Murphy, JD, Nicolson, SC, Steven, JM, Norwood, WI. Results of Norwood's operation for lesions other than hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1995;110:15551562.CrossRefGoogle ScholarPubMed
15.Fraser, CD Jr., Mee, RBB. Modified Norwood procedure for hypoplastic left heart syndrome. Ann Thorac Surg 1995;60:S546549.CrossRefGoogle ScholarPubMed
16.Gustafson, RA, Murray, GF, Warden, HE, Hill, RC, Rozar, GE. Stage 1 palliation of hypoplastic left heart syndtome: The important of neonate construction. Ann Thorac Surg 1989;48:4350.CrossRefGoogle Scholar
17.Jonas, RA, Lang, P, Hansen, D, Hickey, P, Castaneda, AR. Firststage palliation of hypoplastic left heart syndrome: The importance of coarctation and shunt size. J Thorac Cardiovasc Surg 1986;92:613.CrossRefGoogle ScholarPubMed
18.Rao, PS, Koscik, R. Validation of risk factors in predicting recoarctation after initially successful balloon angioplasty for native aortic coarctation. Am Heart J 1995;130:116121.CrossRefGoogle ScholarPubMed
19.Rao, PS. Aortic rupture after balloon angioplasty of aortic coarctation. Am Heart J 1993;125:12051206.CrossRefGoogle ScholarPubMed
20.Fletcher, SE, Nihill, MR, Gtifka, RG, O'Laughlin, MP, Mullins, CE. Balloon angioplasty of native coarctation of the aorta: midtetm follow-up and prognostic factors. J Am Coll Cardiol 1995;25:730734.CrossRefGoogle ScholarPubMed
21.Rao, PS, Galal, O, Smith, PA, Wilson, AD. Five to nine-year follow-up results of balloon angioplasty of native coarcration in infants and children. J Am Coll Cardiol 1996;27:462470.CrossRefGoogle ScholarPubMed
22.Moore, JW, Spicer, RL, Mathewson, JW, Kirby, WC. High-risk angioplasty: Coarctation of the aorta after Norwood stage I. Texas Heart Institute Journal 1993;20:4850.Google Scholar