OBJECTIVE To evaluate the efficiency of percutaneous balloon angioplasty of coarctation of the aorta in children and discuss its risk factors that can lead to poor long-term results. METHODS From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution. There were 19 patients with discrete (membranous) coarctation, 4 patients with long-segment and aortic arch hypoplasia, and 1 patient with postoperative recurrence. The balloon diameter was chosen not to exceed the diameter of the aorta proximal to the stenotic site (11.06 +/- 2.80 mm vs 11.78 +/- 3.18 mm), with the chosen diameter two to four times that of the stenotic segment (2.57 +/- 0.68 times). The patients have been followed up for half to twelve years (mean 6.2 +/- 2.8 years). Satisfactory result was defined as a reduction in the pressure gradient across the site of coarctation to < or = 20 mm Hg. RESULTS The systolic pressure gradient across the coarctation site decreased from 48.17 +/- 14.68 mm Hg to 14.96 +/- 13.12 mm Hg (P < 0.01) and the diameter of the coarctation site increased from 4.66 +/- 2.43 mm to 8.80 +/- 3.32 mm (P < 0.01). Immediate satisfactory results were obtained in 19 patients (79%). Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patients with satisfactory results, 18 patients had membranous coarctation and 1 patient had recurrent postoperative coarctation. No aneurysm and other complications had occurred in any patients at the follow-ups. CONCLUSIONS Percutaneous balloon angioplasty is an effective treatment alternative to surgery in most patients with recurrent postoperative or native membranous coarctation of the aorta. It should not be recommended for the coarctation of aortic arch hypoplasia.