Results of Balloon Angioplasty in Patients with Coarctation of the Aorta

PURPOSE: This study was undertaken to analyze and compare the effects of percutaneous balloon angioplasty(BAP) on postoperative re-coarctation and native coarctation of the aorta(CoA) and to thereby contribute to the development of treatment methods for CoA. METHODS: The subjects in this study were 21 children who had undergone BAP from Jan. 1996 to Dec. 2000 in the Division of Yonsei Pediatric Cardiology. The relation between factors such as pressure and diameter changes across the coarctation segment together with hemodynamic and morphologic variables of children with postoperative re-coarctation and native CoA was analyzed through retrospective study of medical records. RESULTS: Among the 21 cases, 11 children showed a decreased pressure gradient across the coarctation segment of less than 20 mmHg(average : 11+/-5 mmHg) after BAP was performed. In postoperative re-coarctation, the pressure gradient across the coarctation segment significantly fell from 56+/-21(30-90) mmHg to 20+/-13(0-50) mmHg(P<0.001) after BAP, while in native CoA, the pressure gradient decreased from 57+/-13(40-70) mmHg to 22+/-14(10-40) mmHg(P<0.001) after BAP. The diameter of the narrowest coarctation segment was significantly increased in native CoA and postoperative re-coarctation after BAP. The factor that most affected our results was the ratio of isthmic/descending aortic dimension showing an inverse relationship between the ratio of isthmic/descending aortic dimension and pressure gradient after BAP(gamma=-0.473, P=0.030). Complications included one case of femoral artery stenosis, one case of femoral artery interruption, and one case in which seizure occurred two days after BAP due to cerebral thrombosis. CONCLUSION: We conclude that BAP is an effective treatment modality in postoperative re- coarctation and native CoA.

Morphologic change of pulmonary arteries and right ventricular outflow tract after total correction of tetralogy of Fallot: risk factors for pulmonary artery junctional stenosis

BACKGROUND AND OBJECTIVES: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. METHODS: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.119.8 months, follow-up duration after operation 13.95.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. RESULTS: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=.776, p<0.01) and post-operative RVEDP(r=.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade II of residual PI than grade III~IV. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(P, mmHg) =5.43 +16.24*[false aneurysmal change of RVOT] +14.13*[RVOT patch enlargement to LPA] +16.89*PDA. CONCLUSION: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.

A Case of Hemimegalencephaly with Intraventricular Hemorrhage and Multifocal Intraparenchymal Hemorrage on Deep White Matter of Periventricular Area

Hemimegalencephaly is a rare congenital anomaly characterized by a intractable seizure an infantile death. This disease is a migrational disorder with enlargement of unilateral hemisphere, abnormal gyration of the cortex, the presence of large and atypical neuron, hetero trophic neuron at subcortical area and proliferation of astrocyte ect. We observed a neonate with neonatal seizure, and the radiological evaluation revealed abnormal enlargement of right hemisphere, intraventricular hemorrhage of both ventricle and multifocal intraparenchymal hemorrhage on deep white matter of periventricular area on both sides. We used the phenobarbital for treatment of seizure. After phenobarbital treatment. The seizure was controlled. A review of literature was also presented briefly