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[Transluminal balloon valvuloplasty in neonates and infants with critical aortic stenosis]
Ivan Malcić1, Dalibor Sarić, Andrea Dasović-Buljević
1Zavod za pedijatrijsku kardiologiju, Klinika za pedijatriju Rebro, KBC Zagreb, Zagreb, Hrvatsk.
Insights
Balloon valvuloplasty effectively treats critical aortic stenosis in infants, significantly reducing pressure gradients and improving cardiac function without major complications. Long-term results show sustained benefits, with most children remaining asymptomatic.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Critical aortic stenosis poses significant risks in neonates and infants, including low cardiac output and heart failure.
- Left ventricular hypertrophy and dysfunction are key echocardiographic indicators requiring intervention.
Purpose of the Study:
- To evaluate the effectiveness of balloon valvuloplasty in neonates and infants with critical aortic stenosis.
- To assess clinical and echocardiographic outcomes following aortic valve balloon dilatation.
Main Methods:
- Retrospective analysis of 5 pediatric patients undergoing balloon valvuloplasty for critical aortic stenosis.
- Procedure involved manual balloon inflation via femoral artery; outcomes assessed by pressure gradients and echocardiography.
Main Results:
- Mean systolic pressure gradient decreased by 85% (68 to 9 mmHg) post-procedure (p<0.01).
- No significant increase in aortic insufficiency immediately after dilatation; long-term residual gradients remained significantly lower than pre-procedure.
- All patients were clinically asymptomatic post-procedure; some developed mild aortic insufficiency.
Conclusions:
- Balloon valvuloplasty is an effective interventional treatment for critical aortic stenosis in neonates and infants.
- The procedure offers significant hemodynamic improvement and favorable long-term clinical outcomes.
Abstract:
The purpose of this study was to evaluate children who underwent balloon valvuloplasty due to critical aortic stenosis following clinical (low cardiac output, cardiogenic shock, congestive heart failure) and echocardiographic criteria (morphological evidence of left ventricular hypertrophy, with depression of left ventricular function, irrespective of transvalvular gradient). We assessed the effectiveness of balloon valvuloplasty in 5 children (all male) who were submitted to aortic valve balloon dilatation over 3.5 years (10.1998-05.2003). The age at dilatation was 29+/-24 days, BW 3.92+/-0.82 kg and BSA 0.24+/-0.03 m2. In all children the balloon valvuloplasty was performed with manual inflation of balloon at 4-6 bars through the femoral artery. The mean systolic pressure gradient across the aortic valve decreased from 68+/-20.5 mmHg to 9+/-10.95 mmHg, i.e. by 85%, (p<0.01). Aortic valve ring diameter was 9.2+0.84 mm, and balloon/aortic ring ratio 0.8-0.04. The degree of aortic insufficiency immediately after the dilatation did not significantly increase. Dilatation was performed without complications. Long term results were evaluated in all patients 3.2 - 54 months after valvuloplasty and revealed the continuously increasing residual aortic valve gradient (Doppler measurement) 33+/-10.95 mmHg to be significantly lower (p<0.01) than before valvuloplasty. None of the children was showing clinical symptoms of the disease. According to echocardiographic analysis two of them developed aortic valvar insufficiency grade II, two had trivial insufficiency, one was without insufficiency. One child is an candidate for the Ross procedure in future (gradient 50 mmHg, insufficiency grade II, age 4.5 years.). Balloon valvuloplasty provides effective interventional method in the treatment of the neonates and infants with critical aortic stenosis.
