Percutaneous balloon dilatation for congenital aortic stenosis during infancy: A 15-year single-center experience

Abstract

Background:Congenital aortic stenosis (AS) is a rare disease. Treatment options for newborns are challenging. Newborns may have higher reintervention rate and mortality.Objectives:The study aimed to identify the factors predictive of reintervention following balloon aortic valvuloplasty (BAV) for AS during infancy.Methods:Retrospectively, between 2001 and 2016, echocardiography (echo) and cardiac catheterization data for infants with AS were analyzed, including follow-ups and reinterventions. Percentage reduction was defined as the ratio between the drop of aortic valve (AV) peak gradient and the baseline peak gradient.Results:Sixty infants were included and 48 were followed up. Sixteen (27%) patients were neonates. Peak-to-peak gradient at AV was 64 ± 27 mmHg, which was reduced to 27 ± 13 mmHg. Percentage reduction was 53% ±24%. Forty-nine (82%) patients had adequate results (residual AV gradient <35 mmHg). There was no significant aortic insufficiency (AI) before procedure, while 6 (10%) patients had increased AI immediately after BAV. Of 48 patients, 14 (29%) required an additional BAV. Of 48 patients, 8 (17%) required surgical interventions following BAV. Reintervention was associated more with small left ventricular outflow tract (LVOT), high residual AV, and low percentage reduction. Mortality was 8.3%.Conclusions:BAV in infancy has a reasonable success rate (82%) with high rate of reintervention. Patent ductus arteriosus-dependent neonates carried the highest risk of mortality. Small LVOT, high AV residual gradient, and low percentage reduction resulted in more reinterventions.

Prevalence of Bicuspid Aortic Valve and Associated Aortopathy in Newborns in Copenhagen, Denmark

“…13 Considering that congenital aortic stenosis is reported in 4 per 10 000 live births and assuming coexisting BAV in 77% of cases, 8 newborns with BAV and congenital aortic stenosis were expected to be diagnosed in total. 32,33 Although the aortic valve in the vast majority of newborns with BAV was nonstenotic, the higher flow velocities across the valve indicate a smaller functional valve orifice size than in those without BAV, as seen in congenital aortic stenosis. 11 Trivial or mild aortic valve regurgitation was observed in a considerable fraction of newborns with BAV, which indicates incomplete coaptation and possibly suggests discrete prolapse or redundancy in leaflets, as seen in children with BAV with significant aortic regurgitation.…”

“…Considering that congenital aortic stenosis is reported in 4 per 10 000 live births and assuming coexisting BAV in 77% of cases, 8 newborns with BAV and congenital aortic stenosis were expected to be diagnosed in total …”

Balloon dilatation of critical neonatal aortic stenosis: Predictive factors of reintervention

“…Dans cette étude, la mortalité pour la population néonatale est de 18.2%. Dans l'étude de Jijeh (8), 12 enfants sont ducto-dépendants sur les 16 enfants de moins de 30 jours inclus. La mortalité globale est de 8.3%, dont 33% était ductodépendants ce qui en faisait dans cette étude un facteur de risque indépendant de décès.…”

“…Il est classiquement admis que les sténoses valvulaires sont associées à d'autres malformations dans 10 à 20% des cas (8). Dans notre étude 8 patients étaient porteurs d'une autre anomalie cardiaque (22%).…”

The Prognostic Value of Myocardial Deformation in Patients with Congenital Aortic Stenosis

“…Indeed, it is the most frequent indication for aortic valve replacement in young adults [2]. The last few decades research has been focused primarily on re-intervention free survival of different surgical techniques as well as balloon valvuloplasty [3][4][5][6][7][8][9][10]. There are however only a few studies that assess clinical endpoints such as heart failure or mortality [9,11].…”