Related Experiment Videos
[Percutaneous valvotomy of aortic valve stenoses in children]
J Kachaner1, A M Worms, F Bourlon
1Service de cardiologie pédlatrique, hôpital Necker-Enfants malades, Paris.
Insights
Percutaneous aortic valvuloplasty in children with aortic valve stenosis offers a safe alternative to surgery. While effective in reducing pressure gradients, long-term aortic valve function requires monitoring.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Aortic valve stenosis (AVS) is a significant congenital heart defect in children.
- Traditional surgical interventions carry inherent risks and complexities.
- Percutaneous aortic valvuloplasty (PAV) emerged as a less invasive therapeutic option.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous aortic valvuloplasty in pediatric patients.
- To assess the long-term outcomes and complications associated with PAV.
- To compare PAV with conventional surgical approaches for isolated aortic valve stenosis.
Main Methods:
- Retrospective cooperative study involving 12 French centers from 1985.
- Included 90 children (age > 3 months) with isolated aortic valve stenosis.
- Retrograde femoral arterial approach with balloon angioplasty was the primary technique.
Main Results:
- Significant reduction in peak transvalvular pressure gradients (average 39.2 mmHg).
- Primary success rate of 60% (54 children), sustained in 88% of followed cases.
- 17% immediate failures, 17% experienced significant aortic regurgitation.
Conclusions:
- PAV is a simple, economical, and safe alternative to surgery for pediatric AVS.
- PAV demonstrates lower immediate effectiveness compared to surgery.
- Potential for long-term compromise of aortic valve function necessitates careful follow-up.
Abstract:
A retrospective cooperative study of percutaneous aortic valvuloplasty was undertaken in 12 French centres from 1985 and included 90 children over 3 months of age (average 8.5 +/- 5.2 years) treated for isolated aortic valve stenosis with peak transvalvular pressure gradients of 80.7 +/- 23 mmHg. over 50 mmHg in 92% of cases. The majority of cases were performed by a retrograde femoral arterial approach with inflation of a balloon with a diameter approximating that of the aortic annulus. There was one serious complication (lethal collapse occurring before dilatation) and 12% of local complications due to arterial trauma: the latter were temporary or accessible to simple therapeutic measures. Overall, the pressure gradient decreased by an average of 39.2 +/- 25.4 mmHg. There were 15 immediate failures (17%) and 21 partial results (23%) requiring a further procedure at varying intervals after the valvuloplasty. There were 54 primary successes (60%) with annulation of the pressure gradient and this result was sustained in 45 of the 51 cases followed up for an average of 34 +/- 21 months. Aortic regurgitation was observed or aggravated in 29 children; at the end of the study, this remained a serious problem in 15 cases (17%). The authors conclude that interventional catheterisation is an elegant. simple and relatively economical alternative to conventional surgery. It is as safe, but less immediately effective overall; aortic continence may be compromised in the long-term. In the absence of technical innovations, a parallel development of the two therapeutic procedures is to be expected.