Neonatal Coarctation Case Study
Transcathter Management for Neonatal Coarctation
Coarctation of the aorta usually affects the aortic aspect of the insertion of the ductus arteriosus (Isthmus). Theoretically, it might be explained by a abnormal migration of the ductal smooth muscle cells into the periductal area in early the fetal life. This theory can explain the narrowing and constriction of the aorta in the periductal area. 1
Balloon angioplasty has been used for managing coarctation since early 1980s. There is strong evidence supporting its use as an effective and safe alternative for surgery in both native and recurrent post-operative coarctation. In addition, it might be the preferred treatment modality in the recoarctation. 2-5
In the current era, the role of balloon angioplasty for native coarctation in neonates remains controversial due to higher incidence of early restenosis, need for multiple interventions, potential serious vascular injury and limb ischemia, and incidence of aneurysm formation when compared with surgical treatment for the same diagnosis and patient population. However, many reports have concluded that balloon angioplasty should be considered as treatment of choice for all patients with postoperative recoarctation. 6,14-17 …show more content…
This is especially true in very low birth neonates. Emergency primary balloon angioplasty is very effective acutely. It decreases mortality providing a bridge to surgery in critically ill neonates. It relives the heart failure and acidosis. Successful and safe balloon angioplasty has been reported in small neonates weighing as low as 790 grams. However, the rate of developing of recoarctation in primary balloon angioplasty is much higher comparing with surgically treated patients. This rate is more than 50 % in the vast majority of the studies.
Coarctation of the aorta usually affects the aortic aspect of the insertion of the ductus arteriosus (Isthmus). Theoretically, it might be explained by a abnormal migration of the ductal smooth muscle cells into the periductal area in early the fetal life. This theory can explain the narrowing and constriction of the aorta in the periductal area. 1
Balloon angioplasty has been used for managing coarctation since early 1980s. There is strong evidence supporting its use as an effective and safe alternative for surgery in both native and recurrent post-operative coarctation. In addition, it might be the preferred treatment modality in the recoarctation. 2-5
In the current era, the role of balloon angioplasty for native coarctation in neonates remains controversial due to higher incidence of early restenosis, need for multiple interventions, potential serious vascular injury and limb ischemia, and incidence of aneurysm formation when compared with surgical treatment for the same diagnosis and patient population. However, many reports have concluded that balloon angioplasty should be considered as treatment of choice for all patients with postoperative recoarctation. 6,14-17 …show more content…
This is especially true in very low birth neonates. Emergency primary balloon angioplasty is very effective acutely. It decreases mortality providing a bridge to surgery in critically ill neonates. It relives the heart failure and acidosis. Successful and safe balloon angioplasty has been reported in small neonates weighing as low as 790 grams. However, the rate of developing of recoarctation in primary balloon angioplasty is much higher comparing with surgically treated patients. This rate is more than 50 % in the vast majority of the studies.