Balloon Valvuloplasty of Aortic Valve Stenosis in Childhood: Midterm Results in a Children's Hospital, Mansoura University, Egypt

Marshafawy, Hala Al; Sawah, Gehan Attia Al; Hafez, Mona; Matter, Mohammed; Gamal, Adel; Sheishaa, Abdel Gawad; Kair, Magdy Abu El

doi:10.4137/cmc.s8602

Cited by 6 publications

(11 citation statements)

References 38 publications

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“…Our survival analysis, with a mean follow-up of 11.4 ± 7 years, revealed that 88 % of patients were alive at 20 years of age, with two-thirds of the cohort free from surgery and over half free from any reintervention. These findings are in line with the literature [1,6,9]. Nevertheless, a second intervention (either surgery or BAV-36 % in our series) appeared unavoidable in a third of patients in the long term [7,12,13].…”

Section: Discussionsupporting

confidence: 94%

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

et al. 2015

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In the presence of new surgical techniques, the treatment of congenital valvular aortic stenosis is under debate. We reviewed the results and late outcomes of all 93 patients aged 1 day to 18 years, treated with balloon valvuloplasty (BAV) as first-line therapy for congenital aortic valve stenosis in our center from January 1991 to May 2012. Mean age at procedure time was 2.4 years; 37 patients underwent BAV at age ≤30 days (neonates), 29 patients at age ≥1 month and <1 year (infants), and 27 patients were older than 1 year (children). The invasive BAV peak-to-peak aortic valve gradient (mean 59 ± 22 mmHg) was immediately reduced (mean 24 ± 12 mmHg). The observed diminution of gradient was similar for each age group. Four patients had significant post-BAV AI. Mean follow-up after BAV was 11.4 ± 7 years. The last echo peak aortic gradient was 37 ± 18 mmHg and mean gradient was 23 ± 10 mmHg, and two patients had significant AI. Actuarial survival for the whole cohort was 88.2 and 72.9 % for the neonates. All infants, except one, and all children survived. Sixty-six percent of patients were free from surgery, and 58 % were free from any reintervention, with no difference according to age. Freedom from surgery after BAV at 5, 10, and 20 years, respectively, was 82, 72, and 66 %. Our study confirms that BAV as primary treatment for congenital AS is an efficient and low-risk procedure in infants and children. In neonates, the prognosis is more severe and clearly related to "borderline LV."

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Section: Discussionsupporting

confidence: 94%

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

et al. 2015

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“…22,23 We had 100% success in reduction of the Doppler and catheter peak-to-peak gradient across AoV, and this is comparable with the results of many investigators. [21][22][23][24][25][26][27] Our results are comparable with those of Al Marsafawy et al, in Al-Mansoura, Egypt who reported significant reduction of the gradient in all their cases. 26 However, the mortality was higher in their series (10%) compared to ours 2.7%.…”

Section: Discussionsupporting

confidence: 89%

“…[21][22][23][24][25][26][27] Our results are comparable with those of Al Marsafawy et al, in Al-Mansoura, Egypt who reported significant reduction of the gradient in all their cases. 26 However, the mortality was higher in their series (10%) compared to ours 2.7%. Also, similarly, their cases did not need reintervention by ballooning or surgical AoV replacement.…”

Section: Discussionsupporting

confidence: 89%

“…The procedure is considered safe and effective. [21][22][23][24][25][26] Risk factors for poor outcome include poor condition when starting the procedure, young age and small weight at presentation, endocardial fibroelastosis and borderline LV. 22,23 We had 100% success in reduction of the Doppler and catheter peak-to-peak gradient across AoV, and this is comparable with the results of many investigators.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of initial and medium-term follow-up results of balloon aortic valvuloplasty in severe aortic valve stenosis in newborns, infants and children in Alexandria, Egypt

Adel

2019

Int J Community Med Public Health

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Background: Aortic valve stenosis (AVS) represents 3%–7% of all congenital heart diseases. Balloon aortic valvuloplasty (BAoV) has been established as an alternative to surgery for therapy of AVS in infants and children; and has proven to be an effective method for decreasing the gradient between the left ventricle and the aorta. The objective of the study was to evaluate the initial and medium-term results of BAoV in newborns, infants and children with severe AS, treated at the Alexandria University Children’s Hospital.Methods: Thirty-seven newborns, infants and children with severe AS treated by B AoV between 2009 and 2017 were studied. They were followed-up for at least 1year post- ballooning by clinical and echocardiographic evaluation.Results: The mean AoV annulus diameter by echo was 13.1±4.4 mm and by angiographic measurement was 12.8±4.3 mm. The mean Doppler gradient across AoV was 91.8±14.7 mmHg, compared to mean catheter gradient of 66.1±13.4 mmHg. The mean inflated balloon diameter was 12.1±4.1 mm. The mean balloon/AoV annulus ratio by angiogram was 0.94±0.03 (0.88–1). The mean pressure gradient across the AoV post-ballooning was 21.5±6.9 mmHg by Doppler and was 10.3±4.7 mmHg by catheter, both were significantly less than pre-ballooning values (p<0.001). The procedure was successful in all the cases. Only one case died. Post -ballooning aortic incompetence was moderate in 2 cases (5.4%) and severe in only one case (2.7%).Conclusions: Balloon aortic valvuloplasty is an effective and safe technique for relieving severe aortic valvular stenosis with acceptable morbidity and minimal mortality, particularly with the new catheter and balloon technology.

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“…Instantaneous pressure gradient peak and mean were recorded by continuous-wave Doppler tracing in multiple planes, including apical fivechamber, apical three-chamber, right parasternal, subxiphoid long axis, and suprasternal views, and maximum gradients were considered, as shown in Figure 2. The severity of AI was classified as none, trivial, mild, moderate, and severe or graded from 0 to IV [13]. Angiographic parameters were also noted as aortic and LV pressures, AVA size, balloon size, and degree of AI (if any).…”

Section: Figure 1: Chest X-ray Posterior-anterior View Showing Cardiomentioning

confidence: 99%

Early and Intermediate-Term Outcome of Balloon Aortic Valvuloplasty in Children With Aortic Stenosis and Left Ventricular Dysfunction at Tertiary Care Hospital

Chand

Shaikh

Kumar

et al. 2020

Cureus

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Background Left ventricular (LV) dysfunction in patients with aortic valve stenosis (AVS) is seen in two scenarios: in neonates and in elderly patients. Neonatal AVS may present as a congestive cardiac failure (CCF), while older children rarely present with CCF if they have not been diagnosed early. Only a few reports of LV dysfunction with AVS have been described in the literature. However, there is a paucity of data regarding the safety and effectiveness of balloon aortic valvuloplasty (BAV) in children with AVS with LV dysfunction. Therefore, the aim of this study was to evaluate outcomes to establish the safety and effectiveness of BAV in children with AVS and LV dysfunction in improving LV function and survival. Methods A total of 160 BAVs were performed from 2004 to 2017; of these, 41 (25.6%) patients had LV dysfunction. We reviewed these cases, and data were obtained on clinical features, echocardiographic parameters including LV ejection fraction (LVEF) and LV dimensions, LV posterior wall, interventricular septal thickness, pressure gradient across the valve, aortic valve morphology and annulus and aortic insufficiency (AI), and angiographic parameters such as aortic and LV pressures, AI and annulus size, and balloon size. Echocardiography was done before the procedure, one day after intervention, at three months, at six months, and on regular follow-up. Mortality during and after the procedure and at follow-up was reported.

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Balloon Valvuloplasty of Aortic Valve Stenosis in Childhood: Midterm Results in a Children's Hospital, Mansoura University, Egypt

Cited by 6 publications

References 38 publications

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

Evaluation of initial and medium-term follow-up results of balloon aortic valvuloplasty in severe aortic valve stenosis in newborns, infants and children in Alexandria, Egypt

Early and Intermediate-Term Outcome of Balloon Aortic Valvuloplasty in Children With Aortic Stenosis and Left Ventricular Dysfunction at Tertiary Care Hospital

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