Balloon dilatation (valvoplasty) as first line treatment for severe stenosis of the aortic valve in early infancy: medium term results and determinants of survival.

Abstract

Objective-To assess the results of balloon dilatation of the aortic valve as first line treatment, for infints presenting in the first two months of life with cardiac failure caused by severe aortic stenosis. Design-A prospective study of all such infants presenting to a single centre over a three year period. Patients-Of 14 consecutive infants aged <2 months presenting with heart failure due to severe stenosis of the aortic valve, 12 underwent balloon dilatation of the valve. Two infants with hypoplastic left heart syndrome were excluded. Six patients had other significant cardiac malformations, nine had endocardial fibroelastosis. Four infants were moribund at presentation. Interventions-Balloon dilatation was performed through the femoral artery under general anaesthetic, with heparin and antibiotic prophylaxis. Maximum inflated balloon size was selected as equal to or slightly less than the diameter of the aortic valve measured echocardiographically. In two infants balloon dilatation of coexistent severe coarctation was performed at the same time. Results-Dilatation was achieved in all cases. Early survival rate (up to one month) was 75%; 50% survive up to three years. The two deaths occurring <24 hours after dilatation probably related to the infants' poor condition at presentation and the presence of significant left ventricular hypoplasia. The other early death was due to severe mitral regurgitation from papillary muscle dysfunction.All later deaths were related to associated malformations. The difference in left ventricular size (diameter and length) measured echocardiographically at presentation between survivors and those that died is significant (p < 0.002).

Aortic Wall Injury as a Complication of Neonatal Aortic Valvuloplasty

“…Outcomes of the interventional catheterization procedure are comparable to those of surgical valvotomy with regard to relief of aortic stenosis, improvement in left ventricular function, freedom from reintervention, and longterm survival. [3][4][5][6][7][8] BAVP in infants is done exclusively with "off-label" use of balloon catheters because none have been approved for this purpose. Well-described acute procedural complications of BAVP include death, induction of aortic regurgitation, damage to the mitral valve, and vascular injury related to the access vessels.…”

Left Heart Growth, Function, and Reintervention After Balloon Aortic Valvuloplasty for Neonatal Aortic Stenosis

“…[1][2][3][4] BAVP is comparable to surgical aortic valvuloplasty with respect to the primary outcomes of survival, efficacy at relieving AS, and frequency of important complications such as aortic regurgitation (AR). 1,5 Outcomes among neonates with critical AS depend on the anatomic adequacy and functional integrity of left heart structures, as well as the effectiveness of the primary intervention.…”

Are Outcomes of Surgical Versus Transcatheter Balloon Valvotomy Equivalent in Neonatal Critical Aortic Stenosis?

“…5,11 Reported early mortality after balloon aortic valvotomy is comparable to that of surgery. 5,6,[13][14][15][16][17][18] Bu'Lock 13 and KastenSportes 14 reported early mortality of 25% to 30%, which in selected patients may be as low as 10% to 12%. 5,17 When patients with various degrees of hypoplasia of the left-sided structures were included, early mortality estimates have been 24%.…”

“…5,9,11 Similarly, mid-term survival after balloon aortic valvotomy ranges from 50% to 63% 5,13,17 and in selected patients (excluding patients with hypoplastic left heart complex) approaches 88%. 17 Numerous studies have assessed risk factors for death after valvotomy in neonates and small infants with critical aortic stenosis.…”

“…6 Persistence or progression of aortic stenosis is the most common reason for initial reintervention, although with longer follow-up, later reoperations are usually for management of progressive aortic regurgitation. 12 Reintervention after initial balloon aortic valvotomy at mid-term to long-term follow-up ranges from 20% to 60% 5,6,13,14,17 and is higher than reintervention after balloon aortic valvotomy in nonneonatal patients with aortic stenosis. 16 Moore et al 16 reported that the risk of reintervention after balloon aortic valvotomy was increased in children who had more than moderate aortic regurgitation (or abnormal valve cusps).…”