Balloon Aortic Valvuloplasty in the First Year of Life

Abstract

Between February 1988 and September 1993 balloon aortic valvuloplasty was attempted in 33 consecutive patients in the first year of life: 20 patients (61%) were younger than 1 month. Major associated anomalies such as mitral stenosis, coarctation, and hypoplastic left ventricle were found in 11 cases (33%). The balloon dilation of the aortic valve was accomplished through the right carotid cut-down approach in neonates and patients with body weight < 5 kg, through a percutaneous femoral approach in the others; the procedure was completed in all. The peak systolic gradient across the aortic valve measured at catheterization fell from 80 +/- 33 mmHg (range 25-165) before the dilation to 27 +/- 17 mmHg (range 0-65), afterwards (p < 0.0001). The left ventricular ejection fraction increased from 44% +/- 26% to 61% +/- 17%, 24-48 hours after the procedure (p < 0.0001). Aortic insufficiency developed in 17 cases, being moderate in 2, mild in 6, and trivial in 9. Seven patients (21%), all in the first month of life, died within 30 days from the valvuloplasty; major associated anomalies were present in six; the death was due to a procedure related complication in one. No mortality was observed among the patients undergoing valvuloplasty beyond the first month of life. On follow-up (6 months to 6 years) aortic restenosis occurred in 3 cases; 1 was treated by surgical valvotomy, 2 by repeat balloon valvatomy; in another 2 cases, a subvalvular aortic obstruction developed and was relieved by surgical resection. There was no late mortality. Thus, balloon valvuloplasty appears to be an effective palliation for critical aortic stenosis in infancy. Early mortality is mainly related to associated anomalies.

Influence of Balloon Size on Aortic Regurgitation in Neonates Undergoing Balloon Aortic Valvuloplasty—A Retrospective Study Over an 11‐Year Period

“…Balmer et al showed aortic regurgitation following ballooning to be the main indication for surgical aortic valve reintervention in neonates, with this being the indication in 6 out of 11 reinterventions in their neonatal patients. Other studies also confirm that aortic regurgitation remains the main indication of reinterventions following aortic valvuloplasty . In our study population, there was no significant relationship found between the degree of aortic regurgitation following valvuloplasty and need for reinterventions.…”

Valvar Aortic Stenosis

“…Retrograde catheterization via the umbilical artery or vein is restricted to a few days after birth and leads to difficult catheter manipulation [164] but is still favored by some cardiologists [165,166]. Using the femoral artery may leave up to 65% of the femoral arteries occluded [156], apparently without major consequences, so that some cardiologists use the right carotid artery to introduce the catheter [167][168][169][170]. However, other institutions have experienced femoral artery complications in fewer than 10% of patients [49,171].…”

“…Early mortality ranges from 0 to 34% with a median of 25% (Fig. 24.3) and does not differ substantially from surgical mortality over the same period [34,75,139,156,157,160,168,[176][177][178][179][180][181][182][183][184]. Late survival and event-free survival after the procedure are shown in Fig.…”

“…The peak systolic pressure gradient across the aortic valve is reduced initially by about 40-60% on average [45,156,160] with about 18-40% having inadequate relief of the stenosis (residual gradient Ͼ60 mmHg or Ͼ50% of prestenosis gradient) [34,182,185]. Some aortic regurgitation may occur in 10-75% of patients and regurgitation tends to become more frequent and more severe with time after the valvoplasty [34,143,156,160,168,176,183]. Regurgitation, however, is severe in only 5-15% [143,156,160,168,176,178,179,181].…”

“…Some aortic regurgitation may occur in 10-75% of patients and regurgitation tends to become more frequent and more severe with time after the valvoplasty [34,143,156,160,168,176,183]. Regurgitation, however, is severe in only 5-15% [143,156,160,168,176,178,179,181]. In a few patients, immediate surgery may be needed.…”