The objective of this study was to evaluate the effectiveness and safety of
esmolol-induced negative ino- and chronotropism during
stent/balloon angioplasty for
aortic coarctation. Balloon angioplasty and
stent placement have become widely accepted
therapies for native and recurrent
coarctation of the aorta (
CoA).
Trauma to the vessel wall and
stent migration related to forward displacement of the balloon and/or
stent by cardiac output, are the most common complications. Controlling stroke volume and heart rate may assist in balloon stability and accurate deployment of
stents. All methods currently used to achieve this have significant limitations. We describe our experience using
esmolol to control stroke volume and heart rate during balloon/
stent angioplasty of
CoA. We performed a retrospective review of all patients who had intravenous
esmolol during percutaneous treatment of
CoA. Six interventions were performed in six patients: coarctation
stent angioplasty in five patients (two native coarctation) and balloon angioplasty alone in one patient. The median systolic blood pressure achieved during the procedure was 65 mmHg (range, 57-75) representing a median reduction of 40 mmHg (range, 20-80; p = 0.008) from baseline. The median heart achieved was 50 beats/min (range, 20-80), representing a median reduction of 20 beats/min (range, 15-90, p = 0.048) from baseline. Optimal
stent position was obtained in all patients. Intravenous
esmolol controls periprocedural hemodynamics effectively and safely during percutaneous
therapy for
aortic coarctation, thereby aiding accurate
stent placement. Further evaluation of its use during other percutaneous left heart interventions is required.