Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common

Abstract

Objective: To evaluate immediate and midterm results after balloon valvoplasty in a paediatric population with congenital aortic stenosis, giving special consideration to aortic regurgitation. Design: Retrospective study. Setting: Two tertiary referral centres for paediatric cardiology. Patients: 70 consecutive patients, with an age range of 0-16.4 years. Group A infants , 3 months old (n = 21). Group B children . 3 months old (n = 49). Median follow up time was 19.8 months, range 0-158 months. Intervention: All patients underwent balloon aortic valvoplasty. The balloon to annulus ratio was selected at a mean of 0.90 (range 0.67-1.0). Main outcome measures: Doppler gradients and degree of aortic regurgitation. Results: The pressure gradient dropped significantly with the intervention and increased mildly at follow up. Freedom from relevant aortic regurgitation (that is, moderate and severe) was initially lower in group A (75% v 90% after one month) but after two years the difference between the two groups was not significant (50% v 61%). Freedom from reintervention was significantly lower in group A (with 35% v 80%) after three years. Conclusion: Aortic balloon valvoplasty is safe and effective but has a high rate of early reintervention in infants with critical aortic stenosis. The major long term problem is progressive aortic regurgitation, which does not seem to be prevented by the use of small balloons.

Left Heart Growth, Function, and Reintervention After Balloon Aortic Valvuloplasty for Neonatal Aortic Stenosis

“…Subsequent progression from mild or less AR to moderate or severe AR, sometimes after repeated BAVP, occurred at a steady rate over time, with 65% freedom from moderate or severe AR at 5-year follow-up. These figures are in the range of those reported in several prior series of neonates and young infants undergoing BAVP 1,16,17 and mirror the finding reported in older children of chronic progression to moderate or severe AR from lesser grades in the early post-BAVP period. 13,17 Although younger age has been associated with increased risk of acute AR after BAVP overall and AR seems to be more common after neonatal BAVP than after balloon dilation of congenital AS in older patients, age was not predictive of AR in our series.…”

“…These figures are in the range of those reported in several prior series of neonates and young infants undergoing BAVP 1,16,17 and mirror the finding reported in older children of chronic progression to moderate or severe AR from lesser grades in the early post-BAVP period. 13,17 Although younger age has been associated with increased risk of acute AR after BAVP overall and AR seems to be more common after neonatal BAVP than after balloon dilation of congenital AS in older patients, age was not predictive of AR in our series. 13,15 Similar to the findings of other investigators 15,18 and to earlier reports from our center, 12 a larger balloon-annulus ratio increased the risk of significant AR in this series.…”

Validation of Plasma Biomarkers in Degenerative Calcific Aortic Stenosis

“…Other treatment options are aortic valvuloplasty or percutaneous valve replacement. Balloon aortic valvuloplasty is a well-established and well-studied procedure with nontrivial complication rates, very high rates of recurrent stenosis and moderately high rates of aortic insufficiency (5). The clinical and pathomorphological presentation of CAS is quite wide-ranging.…”

Management of Congenital Aortic Stenosis by Catheter Techniques

“…Aortic regurgitation was caused by a combination of commissural avulsion, cusp dehiscence with retraction, cusp tear, central incompetence, perforated cusp, cusp prolapse, or cusp adhesion to the aortic wall (Bacha et al, 2001;Balmer et al, 2004). There is a relationship of this complication to the use of oversized balloons.…”

“…It should be noted that even if the degree of aortic regurgitation is minimal immediately after balloon valvuloplasty, it does not remain so in the medium and long term follow up, it is usually progressive. Explanation for this phenomenon is that blood flow through the aortic valve leads to constant hemodynamic trauma to the valve tissue resulting in progressive tearing, scarring, retraction, and calcification of the valve (Balmer et al, 2004). …”