ABSTRACT
We describe the first successful balloon angioplasty of a coarctation in a 460-g newborn infant with coarctation of the aorta and heart failure. A coronary angioplasty catheter was positioned across the coarctation via a transumbilical approach. The waist of the balloon disappeared on maximal inflation and there was an increase in blood pressure distal to the coarctation and the clinical status improved. A ductus arteriosus was ligated 4 days after angioplasty.
Subject(s)
Angioplasty, Balloon , Aortic Coarctation/therapy , Infant, Premature, Diseases/surgery , Infant, Very Low Birth Weight , Humans , Infant, Newborn , Infant, Premature , MaleABSTRACT
Transluminal balloon angioplasty (BA) was performed in 27 consecutive patients with coarctation of the aorta (COA), including 7 infants with preductal COA, 7 patients with restenosed COA after surgical repair, and 13 older children and 1 adult with unoperated COA. The patients were 4 days to 27 years old. The balloon was positioned across the COA and inflated sequentially to pressures of 100 and 120 psi, each inflation lasting for 5 to 10 seconds. Peak systolic pressure gradient (PSG) across the COA was recorded and an aortogram was performed before and immediately after BA. PSG also was recorded during follow-up studies performed in 13 patients 3 to 24 months after BA. BA was performed without complications in each patient. Immediately after BA, the mean PSG was reduced from 49 +/- 21 to 10 +/- 7 mm Hg (p less than 0.01), and the mean COA diameter increased from 3.9 +/- 1.4 to 9.6 +/- 3.6 mm (p less than 0.01). After a follow-up period of 3 to 24 months, the mean PSG remained low (15 +/- 11 mm Hg) and the mean COA diameter increased to 10.5 +/- 4.6 mm. BA can be performed safely. It can be a useful palliative treatment in seriously ill infants with COA.
Subject(s)
Angioplasty, Balloon , Aortic Coarctation/therapy , Adolescent , Adult , Age Factors , Aortic Coarctation/physiopathology , Aortic Coarctation/surgery , Child , Child, Preschool , Follow-Up Studies , Hemodynamics , Humans , Infant , Infant, Newborn , Palliative CareABSTRACT
M-mode echocardiography was performed on 107 young insulin-dependent diabetic subjects aged 2-24 yr (mean +/- SE: 13.8 +/- 0.4 yr) and 636 age-group matched controls. All patients were normotensive and free of cardiorespiratory symptoms. Diabetic patients showed a high prevalence of echocardiographic abnormalities that increased with age. Mean dimensions of the left atrium, right ventricle, and left ventricle (systolic and diastolic) were increased significantly in diabetic individuals (P less than 0.01). Hypertrophy of the interventricular septum was present in some patients older than 12 yr of age. Mean interventricular septum excursion was markedly decreased in diabetic individuals compared with controls (3.9 +/- 0.1 mm versus 5.6 +/- 0.2 mm, respectively; P less than 0.01). Fifteen percent of the diabetic patients but none of the controls had septal excursions less than 3 mm (2 SD below mean). Patients with decreased septal excursions showed a higher prevalence of other echocardiographic abnormalities than patients with normal septal excursions. Echocardiographic abnormalities did not correlate with either duration of diabetes or glucose control as assessed by hemoglobin A1c and plasma glucose concentrations at the time of echocardiographic testing. The results show a high prevalence of echocardiographic abnormalities in young diabetic subjects that may represent preclinical cardiomyopathy.
