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Percutaneous aortic valvoplasty in congenital aortic valvar stenosis
Carlos Alva1, Agustín Sánchez, Felipe David
1Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo XXI, Mexico City, Mexico. alva1@prodigy.net.mx
Insights
Percutaneous aortic valvoplasty significantly reduces systolic gradients in pediatric patients. While midterm outcomes show some patients require reintervention, many achieve long-term success without further procedures.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Aortic stenosis is a critical condition in children.
- Percutaneous aortic valvoplasty (PAV) offers a less invasive treatment option.
Purpose of the Study:
- To evaluate the immediate and midterm outcomes of percutaneous aortic valvoplasty in a pediatric patient cohort.
- To assess the long-term efficacy and limitations of PAV.
Main Methods:
- Retrospective review of 141 patients who underwent PAV over 13 years.
- Analysis of immediate hemodynamic changes and midterm clinical follow-up data.
Main Results:
- Successful reduction of systolic peak-to-peak gradient from 163 mmHg to 32 mmHg (p < 0.01).
- Mean follow-up of 51 months in 70 patients.
- Actuarial freedom from reintervention was 87% at 182 months.
Conclusions:
- PAV is an effective procedure for reducing aortic stenosis gradients in children.
- Midterm results indicate a need for further prospective, multicentric studies in Latin America.
Objective:
To evaluate immediate and midterm results with percutaneous aortic valvoplasty.
Material And Methods:
We reviewed the records of 141 patients undergoing percutaneous aortic valvopasty over a period of 13 years.
Results:
The patients were aged from 2 months to 40 years, with a mean of 10.9 +/- 9.9 years. Of the total, 90 (63+/%) were male. The initial systolic peak-to-peak gradient decreased from 163 +/- 52 mmHg to 32 +/- 18 mmHg (p < 0.01) after valvoplasty in all 141 patients, while the proportional reduction ranged from 0 to 100%, with a mean of 72 +/- 27%. The index of the size of the balloon to the diameter of the valvar orifice was 0.88 +/- 0.19 in 128 patients. The follow-up ranged from 6 to 168 months, with a mean 51 +/- 48 months in 70 patients. A significant difference was found in those failing after dilation when the initial evaluation was compared to the final evaluation of patients with follow-up. In those failing, the number of patients rose from 12 (17%) to 21 (30%) (p < 0.01). In contrast, in those in whom we achieved success, there was not such a great difference between the initial and final evaluation: 58 (83%) versus 49 (70%) (p < 0.1). The actuarial freedom curve of patients not needing new percutaneous aortic valvoplasty or surgery, by 182 months, was at 87% and 82% respectively.
Conclusion:
We have reviewed the largest series of patients in Latin-America reported thus far after undergoing percutaneous aortic valvoplasty, concentrating on mid term follow-up and limitations. New prospective and multicentric studies are needed from our region.