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Percutaneous balloon aortic valvuloplasty in children: early and long-term outcome
Jacek Kusa1, Jacek Białkowski, Małgorzata Szkutnik
1Department of Congenital Heart Defects and Paediatric Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.
Insights
Percutaneous balloon valvuloplasty (PBV) effectively treats pediatric aortic stenosis, reducing pressure gradients and delaying surgery. Aortic regurgitation is a potential complication requiring monitoring.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Congenital aortic stenosis in children leads to left ventricular (LV) hypertrophy and damage.
- Aortic valve replacement is the definitive treatment for severe aortic stenosis.
- Percutaneous balloon valvuloplasty (PBV) offers temporary LV decompression but its use is debated.
Purpose of the Study:
- To evaluate the immediate and long-term outcomes of PBV for pediatric aortic stenosis.
- To assess the efficacy and safety of PBV in managing congenital aortic stenosis.
Main Methods:
- A cohort of 47 children (4 months–19 years) with congenital aortic stenosis underwent PBV.
- The study was conducted in a single center with consecutive patient enrollment.
Main Results:
- PBV significantly reduced the trans-valvular pressure gradient (81.4 to 30.5 mmHg, p<0.0001).
- No peri-procedural deaths occurred; one patient had femoral artery damage.
- During a mean 38.4-month follow-up, no deaths were reported, but 8 patients required cardiac surgery for aortic regurgitation or treatment failure.
Conclusions:
- PBV serves as an effective palliative treatment for congenital aortic stenosis in children.
- This intervention can postpone the need for surgical intervention until adulthood.
- Aortic regurgitation is the most frequent complication, occasionally necessitating early surgery.
Background:
A significant aortic stenosis in children causes hypertrophy and destructive changes of the left ventricle (LV). Definitive treatment of this condition consists of aortic valve replacement. Temporary decompression of LV may be achieved by surgical valvulotomy or percutaneous balloon valvuloplasty (PBV). The use of the latter method remains controversial.
Aim:
To assess early and long-term effects of PBV of aortic stenosis in children.
Methods:
The study group consisted of consecutive 47 patients (age 4 months - 19 years, mean 8.3 years) with congenital aortic stenosis who were selected for PBV performed in a single centre.
Results:
PBV was performed in 46 patients and caused significant reduction of the trans-valvular pressure gradient (from 81.4+/-21.08 mmHg at baseline to 30.5+/-17.87 mmHg after PBV, p<0.0001). There were no peri-procedural deaths. One local complication occurred - damage of the femoral artery, which was treated surgically. In this patient PBV was not performed. In four patients the procedure was regarded as ineffective. During the mean follow-up of 38.4 (2-108) months there were no deaths, and eight patients underwent various types of cardiac surgery, mainly due to the progression of aortic regurgitation or lack of effects of PBV.
Conclusions:
PBV is an effective palliative method for the treatment of congenital aortic stenosis. This procedure enables the delay of surgery till adulthood. Aortic regurgitation is the most common complication, and sometimes requires early surgical intervention.
