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[Follow-up after dilatation of congenital and acquired aortic stenosis]
1Medizinische Klinik II, Städtische Kliniken Kassel.
Insights
Transfemoral balloon valvuloplasty (TBV) offers immediate relief for aortic valve stenosis in both congenital and acquired cases. However, long-term success is significantly better for congenital aortic valve stenosis due to lower rates of re-stenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Aortic valve stenosis (AVS) is a significant cardiovascular condition.
- Transfemoral balloon valvuloplasty (TBV) is a minimally invasive treatment option for AVS.
- Distinguishing outcomes between congenital and acquired AVS is crucial for treatment planning.
Purpose of the Study:
- To evaluate the immediate and long-term efficacy of transfemoral balloon valvuloplasty (TBV) for aortic valve stenosis.
- To compare the outcomes of TBV in patients with congenital (non-calcified) versus acquired (calcified) aortic valve stenosis.
Main Methods:
- Retrospective analysis of 85 transfemoral balloon valvuloplasty (TBV) procedures performed until December 1987.
- Inclusion of 25 patients with congenital AVS and 58 patients with acquired AVS.
- Assessment of systolic transvalvular pressure gradients pre- and post-procedure, with follow-up invasive pressure measurements.
Main Results:
- TBV significantly reduced systolic transvalvular pressure gradients in both congenital and acquired AVS.
- Immediate procedural success was observed in both groups.
- Long-term follow-up revealed significantly better outcomes for congenital AVS, with rare re-stenosis, compared to acquired AVS where re-stenosis was common.
Conclusions:
- Transfemoral balloon valvuloplasty (TBV) provides comparable immediate hemodynamic improvement for both congenital and acquired aortic valve stenosis.
- The durability of TBV is superior in congenital, non-calcified aortic valve stenosis compared to acquired, calcified aortic valve stenosis.
- Re-stenosis is a significant limitation of TBV in acquired aortic valve stenosis, impacting long-term results.
Abstract:
Until 31 December 1987, a total of 85 transfemoral balloon valvuloplasties (TBV) had been performed for aortic valve stenosis, on 25 patients with noncalcified congenital and 58 (aged 66 +/- 10 years) with acquired (calcified) stenosis. The procedure had to be repeated in two infants because of early re-stenosis. The systolic transvalvular pressure gradient was reduced from 93 +/- 29 (mean +/- SD) to 51 +/- 20 mm Hg in acquired stenoses, and from 87 +/- 24 to 44 +/- 15 mm Hg in congenital stenoses. Invasive pressure measurements in 16 patients with acquired stenosis 3-11 months (mean of 8 months) post-TBV demonstrated partial or complete re-stenosis in all patients. In contrast, only 3 of 17 patients with congenital stenosis had significant re-stenosis 4-38 months (mean of 16 months) after TBV. These results demonstrate that TBV gives similar immediate results in acquired, calcified and congenital, non-calcified aortic stenosis. However, the intermediate and long-term results are much better in the congenital form, because re-stenosis is rare, whereas the primary success failed to persist in any of the patients with the acquired form.