Balloon coarctation angioplasty (BCA) was performed in seven consecutive patients (five boys and two girls) 18 months to 18 years old (mean 9.5) with isolated discrete unoperated coarctation of the aorta. A No. 8F or 9F catheter was chosen with balloon lengths of 30 or 40 mm and maximum inflation diameters 1 mm less than the smallest measured aortic diameter determined 1 cm proximal to the coarctation site. A 10 sec inflation-deflation cycle of 6 to 8 atmospheres (90 to 120 psi) was perforined. coarctation.25 The current report presents our initial and long-term results with seven patients with discrete coarctation. MethodsSeven patients (five boys, two girls) 18 months to 18 years old (mean 9.5) underwent percutaneous balloon dilatation angioplasty for unoperated discrete coarctation of the aorta from December 1983 to December 1984. All patients had clinical evidence of coarctation as manifested by diminished femoral long-term safety and efficacy.pulses, systolic hypertension of the upper extremities, and short grade 2/6 systolic ejection murmur at the left base and back. A chest x-ray, electrocardiogram, two-dimensional, and pulsed Doppler echocardiogram were obtained for each patient. Magnetic resonance images of the thoracic aorta were obtained in all patients after the angioplasty. Two patients underwent magnetic resonance imaging before angioplasty. Informed written consent was obtained for each patient and patients were enrolled in a research protocol approved by the Research and Clinical Projects Committee (IRB). The specific technique employed for our balloon angioplasty has been previously reported.24Follow-up evaluation consisted of repeat physical examination with arm/leg blood pressure determinations by sphygmomanometer, electrocardiography, and two-dimensional and pulsed Doppler echocardiography both 1 month and 1 year after coarctation angioplasty. Magnetic resonance images were obtained in all patients from 1 to 16.5 months (mean 7.1 months) after angioplasty. Electrocardiographically gated magnetic resonance images were obtained in coronal, sagittal, transaxial, and left anterior oblique imaging planes with a 0.6 tesla superconducting magnet to obtain 0.75 to 1 cm thick sections. Repeat aortograms and intra-aortic pullback pressure gradients were obtained in all seven patients.

Vascular regions supplied by the internal mammary artery as a graft demonstrate a significantly reduced endothelium-dependent flow reserve but a preserved endothelium-independent flow reserve as compared to vascular regions supplied by the native internal mammary artery. The selective decrease in endothelium-dependent flow reserve may be due to microvascular changes in the myocardial region supplied by the internal mammary artery after bypass grafting.

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