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[Aortic balloon valvuloplasty in critical aortic stenosis in the newborn and infants]
F Benito Bartolomé1, S Jiménez Casso, C Sánchz Fernändez-Bernal
1Servicio de Cardiología Pediátrica, Hospital Infantil La Paz, Madrid.
Insights
Catheter-balloon valvuloplasty effectively treats critical aortic stenosis in infants, reducing pressure gradients. This initial treatment can be life-saving for neonates and small infants with severe aortic valve stenosis.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Critical aortic stenosis presents a significant challenge in neonates and small infants.
- Balloon valvuloplasty offers a palliative approach for this condition.
- This report details the outcomes of catheter-balloon valvuloplasty at our institution.
Purpose of the Study:
- To evaluate the effectiveness of catheter-balloon valvuloplasty in neonates and infants with critical aortic stenosis.
- To assess the procedural success and immediate outcomes.
- To identify potential complications and long-term implications.
Main Methods:
- Six consecutive infants (2-120 days old) with critical aortic valve stenosis underwent catheter-balloon valvuloplasty.
- Associated cardiac lesions were present in four patients, including coarctation of the aorta, dilated cardiomyopathy, and endocardial fibroelastosis.
- Access was achieved via femoral artery (4 cases) or axillary artery dissection (2 cases).
Main Results:
- The procedure significantly reduced peak systolic ejection gradient (66.1 to 38 mmHg) and left ventricle systolic pressure (136.3 to 115 mmHg).
- No procedure-related mortality occurred.
- Outcomes varied based on associated lesions; two patients with isolated aortic stenosis remain asymptomatic, while others faced complications or required further interventions.
Conclusions:
- Catheter-balloon valvuloplasty is an effective initial treatment for critical aortic stenosis in infants.
- The procedure can be life-saving, particularly in selected cases.
- Careful patient selection and management of associated conditions are crucial for optimal outcomes.
Introduction:
Balloon valvuloplasty in neonates and small infants with critical aortic stenosis is a palliative procedure. The present report describes the results of the technique in our center.
Methods:
From April 1993 to March 1995, six consecutive patients with critical aortic valve stenosis underwent catheter-balloon valvuloplasty. Their ages ranged from 2 to 120 days old (45.5 +/- 47.5 days). Four patients had associated lesions: 2 had coarctation of the aorta, 1 had ischemic dilated cardiomyopathy and 1 had endocardial fibroelastosis. Percutaneous femoral artery access was used in four cases and axillary artery dissection in two.
Results:
The balloon-annulus diameter ratio was 0.92 +/- 0.12. The peak systolic ejection gradient decreased from 66.1 +/- 26.4 to 38 +/- 15.7 mmHg (p < 0.05) and the left ventricle systolic pressure decreased from 136.3 +/- 26.8 to 115 +/- 22.5 mmHg (p < 0.05). There were no mortalities related to the procedure. Both patients who had aortic coarctation developed aortic regurgitation and died after repairing of the coarctation. The patient with endocardial fibroelastosis died during an attempt to perform the Norwood operation (Stage I) and the other patient with ischemic dilated cardiomyopathy survived after cardiac transplantation. The remaining two patients with isolated aortic valve stenosis are currently asymptomatic.
Conclusions:
Catheter-balloon valvuloplasty is an effective procedure in the initial treatment of critical aortic stenosis and may be life saving.