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

Jarupim Soongswang, Brian W. McCrindle, Thomas K. Jones, Robert N. Vincent, Daphne T. Hsu, Michael A. Kuhn, William B. Moskowitz, John P. Cheatham, Dipak H. Kholwadwala, L. Lee Benson, David G. Nykanen

Research output: Contribution to journalArticle

24 Citations (Scopus)

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 follow-up, 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.

Original languageEnglish (US)
Pages (from-to)54-61
Number of pages8
JournalCardiology in the Young
Volume11
Issue number1
StatePublished - 2001
Externally publishedYes

Fingerprint

Norwood Procedures
Balloon Angioplasty
Thoracic Aorta
Dilatation
Ventricular Dysfunction
Kaplan-Meier Estimate
Hypoplastic Left Heart Syndrome
Aortic Coarctation
Mortality
Blood Pressure
Survival
Therapeutics

Keywords

  • Aortic arch obstruction
  • Balloon angioplasty
  • Hypoplastic left heart syndrome
  • Norwood operation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Soongswang, J., McCrindle, B. W., Jones, T. K., Vincent, R. N., Hsu, D. T., Kuhn, M. A., ... Nykanen, D. G. (2001). Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation. Cardiology in the Young, 11(1), 54-61.

Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation. / Soongswang, Jarupim; McCrindle, Brian W.; Jones, Thomas K.; Vincent, Robert N.; Hsu, Daphne T.; Kuhn, Michael A.; Moskowitz, William B.; Cheatham, John P.; Kholwadwala, Dipak H.; Benson, L. Lee; Nykanen, David G.

In: Cardiology in the Young, Vol. 11, No. 1, 2001, p. 54-61.

Research output: Contribution to journalArticle

Soongswang, J, McCrindle, BW, Jones, TK, Vincent, RN, Hsu, DT, Kuhn, MA, Moskowitz, WB, Cheatham, JP, Kholwadwala, DH, Benson, LL & Nykanen, DG 2001, 'Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation', Cardiology in the Young, vol. 11, no. 1, pp. 54-61.
Soongswang, Jarupim ; McCrindle, Brian W. ; Jones, Thomas K. ; Vincent, Robert N. ; Hsu, Daphne T. ; Kuhn, Michael A. ; Moskowitz, William B. ; Cheatham, John P. ; Kholwadwala, Dipak H. ; Benson, L. Lee ; Nykanen, David G. / Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation. In: Cardiology in the Young. 2001 ; Vol. 11, No. 1. pp. 54-61.
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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 follow-up, 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.",
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