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Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up
B K O'Connor1, R H Beekman, A P Rocchini
1Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI 48109-0204.
Insights
Balloon aortic valvuloplasty effectively reduces obstruction in children with congenital aortic stenosis, maintaining results long-term without significant restenosis. This procedure offers a safe and effective intermediate-term solution for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Percutaneous balloon valvuloplasty is acutely effective for congenital valvar aortic stenosis.
- Intermediate- and long-term effectiveness require further documentation.
Purpose of the Study:
- To assess the intermediate-term effectiveness of balloon valvuloplasty in children with congenital aortic stenosis.
Main Methods:
- Repeat catheterization in 27 of 30 children 1.7 years post-valvuloplasty.
- Evaluation of peak aortic stenosis (AS) gradient and left ventricular systolic pressure.
- Assessment of aortic insufficiency and procedural complications.
Main Results:
- Acutely reduced peak AS gradient by 55% (77 to 35 mm Hg) and left ventricular pressure (176 to 138 mm Hg).
- At follow-up (1.7 years), peak AS gradient remained significantly reduced (29 mm Hg) with no significant increase from immediate post-procedure.
- 74% had no change in aortic insufficiency; 4 patients (13%) experienced femoral artery injury, primarily in infants.
Conclusions:
- Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief.
- No early restenosis observed in children and adolescents with congenital AS.
- The procedure demonstrates sustained efficacy for managing pediatric aortic stenosis.
Background:
Percutaneous balloon valvuloplasty has proven to be acutely effective in the treatment of congenital valvar aortic stenosis; however, the intermediate- and long-term effectiveness of the procedure remain to be documented.
Methods And Results:
To assess the intermediate-term effectiveness of balloon valvuloplasty, repeat catheterization was performed in 27 of 30 children 1.7 +/- 0.1 years after balloon valvuloplasty for congenital aortic stenosis (AS). In 33 children the peak AS gradient was reduced acutely by 55% from 77 +/- 4 to 35 +/- 3 mm Hg (p less than 0.001), and left ventricular systolic pressure was reduced from 176 +/- 4 to 138 +/- 4 mm Hg (p less than 0.001). Despite a technically adequate valvuloplasty procedure, three patients had inadequate relief of obstruction and required complex surgical intervention. Twenty-seven of the 30 patients available for late reevaluation (90%) enrolled in the follow-up study. The peak AS gradient remained significantly reduced compared with that present before valvuloplasty (29 +/- 3 versus 77 +/- 4 mm Hg, p less than 0.001). Furthermore, there was no difference in peak AS gradient at follow-up compared with that immediately after valvuloplasty. The greatest increase in gradient at reevaluation was 14 mm Hg. Twenty of 27 patients (74%) had no change in the degree of aortic insufficiency at follow-up compared with that present before valvuloplasty. At follow-up, 16 patients had no aortic insufficiency at all, and only two had moderate-to-severe (3-4+) insufficiency. Femoral artery injury was documented in four patients, three of whom were under 12 months of age at valvuloplasty.
Conclusions:
Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief without early restenosis in children and adolescents with congenital AS.