Follow-up results of balloon aortic valvuloplasty in children with special reference to causes of late aortic insufficiency

Galal, Omar; Rao, P. Syamasundar; Al-Fadley, Fadel; Wilson, Allen D.

doi:10.1016/s0002-8703(97)70183-2

Cited by 72 publications

(190 citation statements)

References 30 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…The approximate 17% restenosis index in a mean 50-month follow-up was similar to that reported in previous publications about balloon catheter valvuloplasty. Similarly to what was found in other case series [25][26][27][28] , gradients above 40 mmHg right after valvuloplasty was associated with restenosis in a shorter period of time in our study. Age < 3 years has also been implicated as a predictor of restenosis 25 .…”

Section: Discussionsupporting

confidence: 92%

“…Similarly to what was found in other case series [25][26][27][28] , gradients above 40 mmHg right after valvuloplasty was associated with restenosis in a shorter period of time in our study. Age < 3 years has also been implicated as a predictor of restenosis 25 . In the absence of contraindications, valvuloplasty may be successfully repeated due to restenosis, as in 2 of our patients and according to the literature 46,47 .…”

Section: Discussionsupporting

confidence: 92%

“…Considering that both the balloon and the scalpel cause variable degrees of fractures in the sites of commissural fusion [50][51][52] , which is the major mechanism of stenosis, the progression of the regurgitation is not a surprising finding. In our and other case series 25,27,28 , the progression of aortic regurgitation to moderate or severe degrees was associated with the need for surgery in a shorter period of time. It is worth noting that the presence of isolated severe aortic regurgitation is not per se an indication of valvular surgery, which is one of the most difficult tasks in cardiology practice and should take other factors into consideration.…”

Section: Discussionsupporting

confidence: 60%

See 2 more Smart Citations

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

Pedra¹,

Pedra²,

Braga³

et al. 2003

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Original ArticleAortic stenosis accounts for 5-6% of the congenital heart diseases and clearly predominates in the male sex 1 . The presence of commissural fusion with a variable thickening and a reduction in the mobility of the valvular leaflets are almost constant anatomic findings 1 . Association with a bicuspid valve is also frequent 1 . Longitudinal studies about the natural history of the disease suggest that the intervention is indicated in the presence of severe stenosis, which is defined by clinical, electrocardiographic, and hemodynamic findings 2 . Surgical valvulotomy has always been the classic therapeutic method considered the gold standard. With the evolution of interventional techniques from the mid 1980s onwards, balloon valvuloplasty started to be used in the initial treatment of aortic stenosis in different age groups with satisfactory short-and midterm results . We report the experience of the teams at the Instituto Dante Pazzanese and the Hospital do Coração with this type of approach. MethodsValvuloplasty was performed in conditions of severe stenosis, classically defined by the presence of a peak-topeak systolic gradient 30,31 detected in the catheterization room or derived from echocardiography 32,33 > 70 mmHg, or, when electrocardiographic alterations (of the T wave or ST segment) or clinical symptoms (dizziness and syncope with no other causes; significant chest pain) were present, a peak-to-peak systolic gradient > 50 mmHg. The procedure was also performed in neonates or young infants (between 1 and 6 months of age) with aortic stenosis and severe ventricular dysfunction, independent of the transvalvular gradient, because in that situation that gradient is underestimated due to the low systemic cardiac output. Valvuloplasty was contraindicated in the presence of moderate and severe aortic regurgitation, of other associated intracardiac lesions requiring immediate surgery, and of a hypoplastic left ventricle requiring palliative surgery, within a therapeutic Objective -To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. Methods -

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 60%

See 1 more Smart Citation

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

Pedra¹,

Pedra²,

Braga³

et al. 2003

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

show abstract

“…Complications, such as arterial occlusion, especially in young children, and aortic insufficiency may occur. Restenosis at intermediate-term follow-up has been reported and could be minimized by reducing the gradients to <30 mmHg and by use of adequate size balloons [15]. There is scanty data on longterm follow-up [7].…”

Section: Pulmonary Stenosismentioning

confidence: 99%

Balloon Valvuloplasty and Angioplasty in Pediatric Practice

Ps¹

2011

Pediatr Therapeut

View full text Add to dashboard Cite

Congenital heart defect (CHD) is the most common congenital anomaly in children and constitutes approximately 1% of live births. This will result in nearly 35,000 babies born with heart defects in the USA alone. Nearly 50% of these babies can be managed with simple medications, observation and follow-up without any major therapeutic intervention. However, the remaining 50%, in the past, required surgical, some under cardiopulmonary bypass, intervention. Since the advent of transcatheter techniques, 50% of these babies can be managed with less invasive, percutaneous, transcatheter techniques. In this editorial the role of balloon valvuloplasty and angioplasty in the management of children with CHDs will be reviewed.In early 1950s, Rubio-Alverez and Limon-Lason used a modified ureteral catheter to perform transcatheter pulmonary and tricuspid valvotomy. A decade later, Dotter and Judkins utilized a gradational transcatheter dilatation technique to open stenotic and occluded peripheral arteries. In mid to late 1970s, Gruntzig and his colleagues extended Dotter and Judkins' technique and successfully dilated stenotic lesions of the iliac, femoral, popliteal, renal and coronary arteries; they utilized a double-lumen catheter with a non-elastic balloon that they developed. Balloon dilatation techniques were then extended to relieve obstructive lesions of the aorta,pulmonary valve, aortic valve, mitral valve,subaortic membrane, branch pulmonary artery stenosis, stenoticbioprosthetic valves and other obstructive vascular lesions. Extensive review of the techniques and results may be found in our previous publications on this subject [1][2][3][4][5][6][7][8]. Pulmonary stenosisValvar pulmonary stenosis, initially described by Kan and her associates [9], is the first CHD for which balloon valvuloplasty is acknowledged as a therapeutic procedure of choice. The indications for catheter intervention are the same as those used for surgical valvotomy: a moderate degree of pulmonary valve stenosis with a peak-to-peak gradient >50 mmHg with normal cardiac index. Initially recommended size of the balloon is 1.2 to 1.4 times that of pulmonary valve annulus. Relief of pulmonary valve obstruction by balloon valvuloplasty is documented in neonates, infants, children and adults. Immediate and short-term results are available but, there are limited long-term follow-up data [7]. Doppler echocardiographic evaluation at followup is reflective of the results without the necessity for repeat cardiac catheterization. Recent studies suggested pulmonary insufficiency as potential problem [7,10,11]. It appears that use of large non-compliant balloons may be associated with pulmonary insufficiency [11]. Consequently the revised recommendations are to achieve balloon/ annulus ratios of 1.2 to 1.25 [12,13]. Balloon pulmonary valvuloplasty is an excellent and preferred alternative to open or closed heart surgery in the treatment of pulmonary stenosis in patients of all age groups. Long-term follow-up evaluation of pulmonary insufficiency is require...

show abstract

“…In a very recent series, including both neonates and older children, 10% of the patients needed reintervention in the long term due to restenosis (Fratz et al, 2008). The survival rate after valvoplasty at 6 and 14.4 years varies between 93% and 100% in older children (Fratz et al, 2008;Galal et al, 1997;Moore et al, 1996;Reich et al, 2004), whereas it varies between 71-74.6% (Fratz et al, 2008;McElhinney et al, 2005) and 71% (Reich et al, 2004) at 10 and 14.4 years respectively when performed in the neonatal period. The freedom from reintervention at mid and longterm follow up varies between 46 and 76% (Fratz et al, 2008;Galal et al, 1997;Moore et al, 1996;Rao, 1999;Reich et al, 2004) after 8-14.4 years in older children, whereas it varies between 47-57.6% (Fratz et al, 2008;McElhinney et al, 2005;Villalba et al, 2002) and 26% (Reich et al, 2004) at 5-10 years and 14.4 years respectively when performed in the neonatal period.…”

Section: Balloon Aortic Valvoplastymentioning

confidence: 99%