Percutaneous transvenous antegrade balloon angioplasty in aortic isthmus stenosis

Balloon angioplasty of native or postoperative coarctation of the aorta has been recommended as an alternative method to surgical treatment. On use of the retrograde approach via the femoral artery, after introduction of the catheter into a vessel of narrow lumen, not infrequently, injury or obstruction was observed. This overview summarizes our experience primarily on use of antegrade balloon angioplasty for coarctation of the aorta, the first description of which was published as a case report in 1986. Between December, 1985, and September, 1987, balloon angioplasty was carried out for native coarctation of the aorta in seven neonates, age two to 30 days. Concomitant cardiovascular anomalies included ventricular septal defect in five, patent ductus arteriosus in five, mitral valve atresia in two and transposition of the great arteries with and without double outlet right ventricle in two (Table 1). Prior to balloon angioplasty for coarctation, in four neonates therapeutic balloon atrial septostomy had been performed. For balloon angioplasty, via the right femoral vein, an end-hole catheter was advanced into the right ventricle. In five neonates, the catheter could be advanced into the ascending aorta directly from the right ventricle or through a ventricular septal defect. In the two other neonates, the catheter was advanced via the foramen ovale and the mitral valve into the left ventricle and the ascending aorta. Pressure was measured by the end-hole catheter as well as in the femoral artery after direct puncture.(ABSTRACT TRUNCATED AT 250 WORDS)