Critical aortic stenosis in the neonate: A multi-institutional study of management, outcomes, and risk factors

Lofland, Gary K.; McCrindle, Brian W.; Williams, William G.; Blackstone, Eugene H.; Tchervenkov, Christo I.; Sittiwangkul, Rekwan; Jonas, Richard A.

doi:10.1067/mtc.2001.111207

Cited by 239 publications

(178 citation statements)

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“…The procedure was also performed in neonates or young infants (between 1 and 6 months of age) with aortic stenosis and severe ventricular dysfunction, independent of the transvalvular gradient, because in that situation that gradient is underestimated due to the low systemic cardiac output. Valvuloplasty was contraindicated in the presence of moderate and severe aortic regurgitation, of other associated intracardiac lesions requiring immediate surgery, and of a hypoplastic left ventricle requiring palliative surgery, within a therapeutic univentricular algorithm [34][35][36] . Written consent was obtained from the patients or their guardians after a detailed explanation about the procedure.…”

Section: Methodsmentioning

confidence: 99%

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

Pedra¹,

Pedra²,

Braga³

et al. 2003

Arq. Bras. Cardiol.

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Original ArticleAortic stenosis accounts for 5-6% of the congenital heart diseases and clearly predominates in the male sex 1 . The presence of commissural fusion with a variable thickening and a reduction in the mobility of the valvular leaflets are almost constant anatomic findings 1 . Association with a bicuspid valve is also frequent 1 . Longitudinal studies about the natural history of the disease suggest that the intervention is indicated in the presence of severe stenosis, which is defined by clinical, electrocardiographic, and hemodynamic findings 2 . Surgical valvulotomy has always been the classic therapeutic method considered the gold standard. With the evolution of interventional techniques from the mid 1980s onwards, balloon valvuloplasty started to be used in the initial treatment of aortic stenosis in different age groups with satisfactory short-and midterm results . We report the experience of the teams at the Instituto Dante Pazzanese and the Hospital do Coração with this type of approach. MethodsValvuloplasty was performed in conditions of severe stenosis, classically defined by the presence of a peak-topeak systolic gradient 30,31 detected in the catheterization room or derived from echocardiography 32,33 > 70 mmHg, or, when electrocardiographic alterations (of the T wave or ST segment) or clinical symptoms (dizziness and syncope with no other causes; significant chest pain) were present, a peak-to-peak systolic gradient > 50 mmHg. The procedure was also performed in neonates or young infants (between 1 and 6 months of age) with aortic stenosis and severe ventricular dysfunction, independent of the transvalvular gradient, because in that situation that gradient is underestimated due to the low systemic cardiac output. Valvuloplasty was contraindicated in the presence of moderate and severe aortic regurgitation, of other associated intracardiac lesions requiring immediate surgery, and of a hypoplastic left ventricle requiring palliative surgery, within a therapeutic Objective -To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. Methods -

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Section: Methodsmentioning

confidence: 99%

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

Pedra¹,

Pedra²,

Braga³

et al. 2003

Arq. Bras. Cardiol.

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“…The extent of LV endocardial fibroelastosis was graded according to the system of the Congenital Heart Surgeons' Society (CHSS). 2 …”

Section: Dimensions Of Left Heart Structuresmentioning

confidence: 99%

“…[1][2][3][4] BAVP is comparable to surgical aortic valvuloplasty with respect to the primary outcomes of survival, efficacy at relieving AS, and frequency of important complications such as aortic regurgitation (AR). 1,5 Outcomes among neonates with critical AS depend on the anatomic adequacy and functional integrity of left heart structures, as well as the effectiveness of the primary intervention.…”

mentioning

confidence: 99%

“…2,3,6 -8 In many patients with critical AS, not only is the aortic valve stenotic and dysplastic, but the aortic valve annulus and additional components of the left heart complex are hypoplastic as well. 2,3 The ability of the small left heart to support the systemic circulation effectively in both the short and long term may depend in part on the growth of left heart structures to normal dimensions. However, even if normalization of left heart dimensions occurs after BAVP, persistent or acquired functional abnormalities of the aortic valve, left ventricle (LV), and mitral valve (MV) may have an impact on the long-term outcome of these patients.…”

mentioning

confidence: 99%

“…Similarly, there are limited data concerning the frequency and predictors of reintervention/intervention on left heart structures after neonatal BAVP. In this study, we investigated the growth and function of the left heart after BAVP for valvar AS in neonates and infants Յ60 days of age by assessing (1) short-and intermediate-term growth/change in dimensions of left heart structures, (2) effects of persistent AS or acquired AR on short-and intermediate-term left heart dimensions, (3) development or persistence of left heart functional abnormalities, and (4) frequency of and factors associated with reintervention on the aortic valve and/or intervention on other left heart structures.…”

mentioning

confidence: 99%

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

et al. 2005

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Background-Transcatheter balloon aortic valvuloplasty (BAVP) has become the first-line treatment for critical aortic stenosis (AS) in neonates. However, little is known about the growth and function of left heart structures or about patterns of reintervention on the left heart after neonatal BAVP. Methods and Results-Between 1985 and 2002, 113 patients underwent neonatal BAVP at Յ60 days of age. There were 16 early deaths (14%), with a significant decrease from 1985 to 1993 (22%) to 1994 to 2002 (4%), and 6 patients had successful early conversion to a univentricular circulation. In the short term, the mean relative gradient reduction was 54Ϯ26%, and significant aortic regurgitation (AR) developed in 15% of patients. The 91 early survivors with a biventricular circulation were followed up for 6.3Ϯ5.3 years, during which time there was a steady increase in the frequency of significant AR. Freedom from moderate or severe AR was 65% at 5 years. In almost all patients with a baseline aortic annulus z score less than Ϫ1, the annulus diameter increased to within the normal range within 1 to 2 years. Similarly, left ventricular (LV) end-diastolic dimension z scores, which ranged from Ϫ5 to 7.5 before BAVP, normalized within 1 to 2 years in nearly all patients with a predilation z score less than Ϫ1. Among early survivors with a biventricular circulation, reintervention-free survival on the LV outflow tract was 65% at 1 year and 48% at 5 years, with younger age, higher pre-and post-BAVP gradients, and a larger balloon-annulus diameter ratio associated with decreased reintervention-free survival (PϽ0.01). Seventeen surgical interventions were performed on the aortic valve in 15 patients, including replacement in 7. Survival free from aortic valve replacement was 84% at 5 years. Conclusions-BAVP for AS during the first 60 days of life results in short-term relief of AS in the majority of patients.Among early survivors, initially small left heart structures may be associated with worse subacute outcomes but typically normalize within 1 year. Reintervention for residual/recurrent AS or iatrogenic AR is relatively common, particularly during the first year after BAVP, but aortic valve replacement during early childhood is seldom necessary.

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2003

The Natural and Modifed History of Congenital Heart Disease

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Critical aortic stenosis in the neonate: A multi-institutional study of management, outcomes, and risk factors

Abstract: Morphologic and functional factors can be used to predict optimal pathway and survival benefit in neonates with critical left ventricular outflow obstruction.

Cited by 239 publications

References 45 publications

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

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

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

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