Aortic balloon valvuloplasty and mid-term results in newborns: a single center experience

Abstract

Background and Objectives. Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short- and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. Methods. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Results. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 ± 4.9 years (range: 6 months - 19 years). The mean age of the patients at the first ABV was 14.5 ± 10.6 days (range: 1-30 days) and body weight was 3.25 ± 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 ± 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 ± 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. In the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p < 0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. Conclusions. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.

Frequency and risk factors of acute and permanent femoral arterial occlusion in neonates with congenital heart disease who undergo ultrasound˗guided femoral arterial access

“…A study reported that 12.3% of patients had no palpable pulse on discharge despite sufficient time for streptokinase and tissue plasminogen activator treatment. 3 In our cohort, we detected PFAO and well-developed collateral circulation using US imaging in 19(5.9%) patients at the end of the 12-week dual treatment.…”

“…Femoral arterial access (FAA) is challenging and even in experienced hands it can be a lengthy procedure in neonates and low-weight infants. [2][3][4]10,11 Previous studies have shown that ultrasound-guided vascular access (US-GVA) increases the success rate and first attempt success rate and decreases failure rate, number of attempts, vascular access time, and vascular arterial complications. 5,7,[10][11][12] Although the evidence level of US-GVA was classified as 1B for vessel cannulation in adults, no level of evidence has been reported for FAA in children.…”

Three years of interventional pediatric cardiology experience in a newly built city hospital

“…Varan et al ( 16) reported moderate and severe valve insufficiency in 17 patients (26.2%) after valvuloplasty in their series of 65 cases. In order to reduce postprocedural valve regurgitation, the postoperative pressure gradient should be reduced to 30-35 mmHg, and the balloon diameter should be chosen to be 0.8-0.9 times the aortic annulus (16). In the follow-up of our patients, it was observed that aortic valve regurgitation ranged from minimal to first degree.…”

Risk factors and frequency of acute and permanent femoral arterial occlusion in neonates with CHD who undergo ultrasound-guided femoral arterial access

“…Its frequency in neonates has been reported to be between 19 and 62%. [1][2][3] Previous studies have reported variables including younger age, lower weight, prolonged vessel access and procedure times, increased number of attempts, large sheath size, sheath exchange, interventional procedure, access technique, operator experience, activated clotting time <250 seconds, and the diameter of the femoral artery <3 mm for arterial occlusion as risk factors. 1,[4][5][6][7][8][9] Femoral arterial access is challenging, and even in experienced hands, it can be a lengthy procedure in neonates and low-weight infants.…”

“…1,[4][5][6][7][8][9] Femoral arterial access is challenging, and even in experienced hands, it can be a lengthy procedure in neonates and low-weight infants. [2][3][4]10,11 Previous studies have shown that ultrasound-guided vascular access increases the success rate and first attempt success rate and decreases failure rate, number of attempts, vascular access time, and vascular arterial complications. 5,7,[10][11][12] Although the evidence level of ultrasound-guided vascular access was classified as 1B for vessel cannulation in adults, no level of evidence has been reported for femoral arterial access in children.…”