Aortic balloon dilatation for congenital aortic stenosis: report of 90 cases (1986-98)

Abstract

OBJECTIVE To review 12 years of experience of balloon aortic valvoplasty in childhood. DESIGN Early and mid-term clinical and instrumental evaluation of 104 consecutive balloon aortic valvoplasties performed from 1986 to 1998. SETTING A tertiary referral centre for congenital heart disease. PATIENTS 90 patients with congenital aortic stenosis: 20 neonates (group 1), 16 infants (group 2), and 54 children (group 3). INTERVENTIONS Balloon aortic valvotomy. MAIN OUTCOME MEASURES Doppler and peak to peak aortic gradient before and after valvoplasty, degree of aortic regurgitation before and after valvoplasty, early and late mortality, need for repeat intervention or surgery. RESULTS Balloon aortic valvoplasty produced a gradient reduction of > 50% in 59 patients, 12 having a residual peak to peak gradient of > 50 mm Hg. Early mortality included three procedure related and six procedure unrelated deaths. There were no intraprocedural deaths. Grade III aortic regurgitation occurred in 20 patients. Five non-lethal complications occurred. At a mean follow up of 5.1 (group 1), 5.7 (group 2), and 7.6 years (group 3), survival was 75%, 88%, and 96%, respectively. Redilatation was performed in three patients in group 1, one in group 2, and 10 in group 3. Surgery was necessary for six in group 1, one in group 2, and eight in group 3. Freedom from events at last follow up was 50%, 75%, and 64%, respectively. There was a residual maximum Doppler gradient of < 30 mm Hg in 22 patients and > 60 mm Hg in 23; 50 patients have mild to moderate aortic regurgitation. CONCLUSIONS Balloon aortic valvoplasty is effective and repeatable and offers good palliation for congenital aortic stenosis in childhood.

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

“…The approximate 17% restenosis index in a mean 50-month follow-up was similar to that reported in previous publications about balloon catheter valvuloplasty. Similarly to what was found in other case series [25][26][27][28] , gradients above 40 mmHg right after valvuloplasty was associated with restenosis in a shorter period of time in our study. Age < 3 years has also been implicated as a predictor of restenosis 25 .…”

Our medium-term results with aortic balloon valvuloplasty and factors affecting development of aortic regurgitation

“…Literatürde benzer şekilde mortalite ile sonuçlanan duktus hasarı bildirilmiştir (10). ABV'ye bağlı mortalitenin daha çok yeni doğanın kritik aort darlıklarında ve ağır SV sistolik fonksiyon bozukluğuyla giden aort darlıklarında olduğu bildirilmektedir (6,17,20). Borghi ve ark.ları (6) tüm yaş gruplarında erken mortalite oranını %10, bir ayın altında çoğu genel durumu kötü olan hastalarda %25 olarak bildirmişlerdir.…”

“…Heparin perfüzyonuna cevap alınmayan 3 hastaya intravenöz streptokinaz verildi. ABV'nin en korkulan komplikasyonlarından biri olan arteryel yaralanmaya bağlı olarak mortalite nadiren bildirilmişse de medikal ve cerrahi tedavi gereksinimi sıklıkla bildirilmektedir (6,18,19). Bu konudaki en kapsamlı çalışmalardan biri olan VACA (Valvuloplasty and Angioplasty of Congenital Anomalies registry) kayıtlarında %3 olguda cerrahi tedavi gerekmiş, %2.5 oranında nabız kaybı devam etmiştir (18).…”

“…Aort yetersizliğindeki artış Labadibi'nin ilk serisinde %43 iken, farklı çalışmalarda ise %7-59 olarak bildirilmiştir (1-4). Belirgin AY görül-me sıklığı ise %2.2-29 olarak bildirilmiştir (5)(6)(7)11). AY komplikasyonunun anülüs çapından büyük (oversized) balon ile valvüloplasti yapılanlarda daha sık olduğunu gösteren çalışmalar olduğu gibi, ilişkili bulmayan araştırmalar da vardır (12)(13)(14)(15)(16)(17).…”

“…İnfantil dönemde yapılan ABV sonrası AY gelişiminin daha sık gözlendiği de bildirilmiştir (6,26). Fratz ve ark.ları (26) ABV'den sonra orta ve ciddi AY sıklığını; bir aydan küçük olgularda %29, 1 aydan büyüklerde %19 olarak bildirmişlerdir.…”