Balloon aortic valvuloplasty in children: a multicenter study in Japan
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1Department of Pediatrics, National Cardiovascular Center, Suita, Osaka, Japan. tomitah@hsp.ncvc.go.jp
Insights
Percutaneous transluminal aortic valvuloplasty (PTAV) effectively reduces pressure gradients in children with aortic stenosis. However, aortic regurgitation may worsen, and pressure gradients can return over time.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Valvular aortic stenosis is a significant congenital heart defect in children.
- Percutaneous transluminal aortic valvuloplasty (PTAV) is an alternative to surgical intervention.
- Long-term outcomes of PTAV in pediatric populations require further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of PTAV in Japanese children with valvular aortic stenosis.
- To identify factors influencing the success of PTAV.
- To assess the long-term progression of aortic regurgitation and pressure gradients after PTAV.
Main Methods:
- A retrospective analysis of 76 PTAV procedures in 72 children across 8 Japanese institutions.
- Data collected via questionnaire, including pre- and post-procedure pressure gradients and aortic regurgitation (AR) severity.
- Follow-up data analyzed for 26 procedures with clinically effective outcomes.
Main Results:
- PTAV significantly reduced the mean pressure gradient from 68±25 mmHg to 33±22 mmHg (p<0.01).
- Aortic regurgitation increased by at least one grade in 34% of cases; no predictors for AR increase were identified.
- Good pressure gradient reduction was achieved in 58% of procedures, influenced by larger diameters (ring, balloon, and ratio).
- During a mean 4-year follow-up of effective procedures, AR progressed in 42% and gradients re-developed in 8%.
Conclusions:
- PTAV is an accepted and useful treatment for pediatric valvular aortic stenosis in Japan.
- Progressive aortic regurgitation and re-development of pressure gradients are potential long-term complications.
- Careful patient selection and monitoring are essential following PTAV in children.
Abstract:
A questionnaire was used to survey the experience of 8 Japanese institutions with percutaneous transluminal aortic valvuloplasty (PTAV) in children. Among 99 procedures reported in 88 patients, sufficient data for analysis was obtained from 76 procedures in 72 patients. In those 76 procedures the pressure gradient decreased significantly from 68+/-25 (20-140) to 33+/-22 (0-100) mmHg (p<0.01), whereas aortic regurgitation (AR) increased at least one grade in 26 cases (34%). None of the parameters analyzed in this study were predictors of an increase in AR. The reduction in pressure gradient was judged as good in 44 of the 76 procedures (58%). A larger ring diameter, larger balloon diameter and larger ratio balloon diameter/the normal predicted diameter of the aortic valve ring significantly contributed to an effective reduction of pressure gradient. Follow up data (mean interval, 4 years) was available for 26 of 39 clinically effective procedures. AR progressed at least 1 grade in 11 (42%), and the pressure gradient re-developed to more than 50mmHg in 2 cases (8%). In Japan, PTAV has been accepted as a useful procedure for valvular aortic stenosis in children, but progressive AR or re-development of the pressure gradient is not uncommon even after clinically effective PTAV.
