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Double-balloon aortic valvuloplasty at Queen Sirikit National Institute of Child Health
Background:
Balloon aortic valvuloplasty is the treatment of choice in moderate and severe valvular aortic stenosis. In order to reduce the risk of vascular complications, a double-balloon technique has been used with good results.
Objective:
To present the results od double-balloon aortic valvuloplasty at QSNICH.
Materials And Method:
Consecutive cases of severe valvular aortic stenosis treated with double-balloon aortic valvuloplasty at QSNICH were recruited in the study. Data were obtained from the medical records starting from the day of presentations to December 2011.
Results:
There were six cases of severe valvular aortic stenosis treated with double-balloon aortic valvuloplasty at QSNICH from 2004 to 2011. The age and weight ranged from 7 months to 12 years and 6 to 53.8 kilograms, respectively. The presenting symptoms were dyspnea in 3 (50%) and asymptomatic heart murmur in 3 cases (50%). Peak-to-peak pressure gradient (PG) before the procedure ranged from 48-104 mmHg (mean 70.00, SD 18.92 mmHg). Immediately after the procedure, PG significantly decreased to 15-52 mmHg (mean 34.33, SD 14.98 mmHg, p < 0.01). On the following day after the procedure, peak instantaneous pressure gradient (PIPG) obtained from echocardiogram ranged from 17-47 mmHg (mean 36.50, SD 10.93 mmHg). PIPG were not significantly different from PG immediately after valvuloplasty. There were two cases with partial femoral occlusion. The duration of follow-up ranged from 6-54 months (median 24 months). In the follow-up period, all of the patients were asymptomatic with functional class I. Echocardiogram after the procedure revealed no significant aortic regurgitation in any of the cases.
Conclusion:
Double-balloon aortic valvuloplasty can be performed safely with very good intermediate term outcome in selected patients. Long-term outcome in Thai children should be further studied.