Aortic Wall Injury as a Complication of Neonatal Aortic Valvuloplasty

Abstract

Background-Transcatheter balloon aortic valvuloplasty for critical aortic stenosis in neonates is routinely performed without recognized complication. Aortic wall injury has rarely been observed after balloon aortic valvuloplasty, although the incidence of this complication is unstudied. We reviewed single-center data to determine the incidence of aortic injury during balloon aortic valvuloplasty and to identify risk factors. Methods and Results-This retrospective study included all patients Ͻ2 months of age who underwent balloon aortic valvuloplasty at our institution from 1985 to 2007. We defined aortic wall injury as an intimal flap, dissection, or vessel rupture as diagnosed by angiography, echocardiography, or direct surgical or postmortem inspection. Primary imaging data were reviewed, as were all procedural and pathology reports, to identify cases of aortic wall injury. Patient and procedural variables were analyzed. Of 187 procedures performed, 28 procedures resulted in aortic wall injury (15%). Injury was recognized at the time of the procedure in only 16 cases (57%). Intimal flaps occurred most commonly in the distal ascending aorta (nϭ13), most often involving the greater curvature. In multivariate analysis, severe ventricular dysfunction at the time of the procedure (odds ratio, 2.8; Pϭ0.02), greater number of balloon dilation attempts per procedure (odds ratio, 1.5; Pϭ0.005), and novice interventional staff (odds ratio, 2.5; Pϭ0.05) were associated with aortic injury. Incidence of injury was not different in the recent era compared with earlier experience. Conclusions-Aortic

Thoracic aortic dissection and rupture in conotruncal cardiac defects: A population-based study

“…The paper also noted that the aortic dissections in this age group were predominately not present on hospital admission, but occurred during hospitalization -a fact suggesting that the dissections occurred as complications of procedures. Brown et al also described aortic dissections and other aortic wall injuries in infants secondary to catheterbased intervention for aortic stenosis or hypoplastic left heart syndrome, which were the diagnoses in 2 of the infants with TAD in our study [48]. Based on these prior papers, we had decided to exclude infants from the multivariable analysis, as our goal was to provide insight into the prevalence of aortic dissection in conotruncal heart disease to clinicians faced with the clinical question of how to manage children, teenagers, and adults with coexisting conotruncal heart disease and aortic dilation.…”

Aortic Dissection in Hospitalized Children and Young Adults: A Multiinstitutional Study

“…In addition, interventional cardiac catheterizations, especially those involving balloon angioplasty or valvuloplasty of aortic structures, have been associated with AD. [22][23][24] The data from this study suggest that AD does occur more frequently at some point during hospitalization rather than at the time of admission. Furthermore, these patients were more likely to have undergone a non-AD-related cardiac procedure during their hospitalization, suggesting that AD in some of the patients may have been a complication after cardiac intervention.…”

Aortic Wall Injury: Intimal Flap Formation after Aortic Balloon Valvuloplasty, a Rare Complication

“…Brown et al (5) published the results of a single-centered study in Boston in 2008. The objective of this research was to determine the incidence of aortic wall injury and other complications during TBAV.…”

“…Specifically, the creation of an intimal flap in the aortic wall is a rarely defined complication after neonatal TBAV. As this complication is frequently overlooked, the aorta should be carefully examined in terms of wall injury after TBAV (5).…”