Transcatheter management of neonatal aortic stenosis

Stapleton, Gary

doi:10.1017/s1047951114002030

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…The usually recommended balloon/annulus ratios are 0.7-1.0. Nevertheless, higher ratios might be required for an effective dilatation due to the rigidity of severely dysplastic AVs [8,10,14,29]. In our analysis, the balloon/annulus ratios were from 0.9 in the first BAV up to a maximum of 1.23 in the third BAV.…”

Section: Discussionmentioning

confidence: 61%

“…It should always be aimed at LV pressure relief by enlargement of the aortic valvular orifice. It is still controversially discussed which technique-transcatheter balloon aortic valvulotomy (BAV) or cardiac surgery-is more beneficial [3,[10][11][12][13][14][15][16]. Transcatheter BAV, first described by Labadibi et al [17], has become the standard of care in most centers.…”

Section: Introductionmentioning

confidence: 99%

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Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle

Pfeifer,

Rentzsch,

Poryo

et al. 2024

JCDD

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Congenital critical aortic valve stenosis (CAVS) is a life-threatening disease requiring urgent treatment. First-line therapy is still controversial. The aim of our study was (1) to analyze retrospectively the patients of our institution who underwent balloon aortic valvuloplasty (BAV) due to CAVS and (2) describe the techniques for improved feasibility of intervention using microcatheters and retrieval loops. Twelve patients underwent 23 BAVs: 1 BAV was performed in 3 patients, 2 BAVs were performed in 7 patients, and 3 BAVs were performed in 2 patients. The peak trans-valvular pressure gradient (Δp) and left ventricular shortening fraction (LVSF) improved significantly in the first two interventions. In the first BAV, Δp decreased from 73.7 ± 34.5 mmHg to 39.8 ± 11.9 mmHg (p = 0.003), and the LVSF improved from 22.3 ± 13.5% to 31.6 ± 10.2% (p = 0.001). In the second BAV, Δp decreased from 73.2 ± 33.3 mmHg to 35.0 ± 20.2 mmHg (p < 0.001), and the LVSF increased from 26.7 ± 9.6% to 33.3 ± 7.4% (p = 0.004). Cardiac surgery during the neonatal period was avoided for all children. The median time to valve surgery was 5.75 years. Few complications occurred, namely mild-to-moderate aortic regurgitation, one remediable air embolism, and one intimal injury to the ascending aorta. We conclude that BAV is a successful emergency treatment for CAVS, resulting in left ventricular relief, clinical stabilization, and a time gain until cardiac surgery.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle

Pfeifer,

Rentzsch,

Poryo

et al. 2024

JCDD

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“…In patients with aortic valve stenosis at early ages, each cardiac surgical group has adopted either surgery 7 or interventionism as the initial management method to relieve obstruction of the left ventricular outflow tract. Both procedures yield equivalent outcomes in the context of isolated valve stenosis 8 , 9 .…”

Section: Discussionmentioning

confidence: 99%

“…According to biomedical literature, factors leading to an increased risk of reintervention include hypoplastic aortic ring, high post-procedure gradient, other associated left ventricular outflow tract obstruction lesions, aortic valve dysplasia, or the presence of a unicuspid aortic valve. However, aortic valvuloplasty 7 is considered to be safely performed with a significant impact on improving the patient’s immediate hemodynamic status.…”

Section: Discussionmentioning

confidence: 99%

Aortic valvuloplasty under echocardiographic guidance in a minor infant at a national referral center in Peru: case report

Catalán Cabrera,

Condori Alvino

2024

Arch Peru Cardiol Cir Cardiovasc

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Aortic stenosis is a congenital heart defect that causes a fixed left ventricular outflow obstruction with a progressive course. Symptomatology in neonates and young infants resembles congestive heart failure. In addition, the diagnosis of this condition is made by imaging, through echocardiography. On the other hand, treatment can be surgical or interventional under fluoroscopic guidance, depending on the hospital in which it is performed. We describe the case of a minor infant patient who presented severe aortic valve stenosis; however, the fluoroscopy equipment was not available at the time of the emergency to perform the appropriate procedure, therefore, an aortic valvuloplasty was performed under echocardiographic guidance without complications.

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“…It was 8.3% in our cohort, which is comparable to previous reports with mortality around 9%–11%. [ 3 7 9 10 ] Death was associated with small AV annulus and LVOT-Z score, depressed LV function, high BAR, low percentage reduction by cath, and PDA-dependent systemic circulation [ Table 4 ]. Probably higher BAR is a reflection of low cath percentage reduction and the need for use of larger balloons to try to get the maximum response.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous balloon dilatation for congenital aortic stenosis during infancy: A 15-year single-center experience

et al. 2018

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Background:Congenital aortic stenosis (AS) is a rare disease. Treatment options for newborns are challenging. Newborns may have higher reintervention rate and mortality.Objectives:The study aimed to identify the factors predictive of reintervention following balloon aortic valvuloplasty (BAV) for AS during infancy.Methods:Retrospectively, between 2001 and 2016, echocardiography (echo) and cardiac catheterization data for infants with AS were analyzed, including follow-ups and reinterventions. Percentage reduction was defined as the ratio between the drop of aortic valve (AV) peak gradient and the baseline peak gradient.Results:Sixty infants were included and 48 were followed up. Sixteen (27%) patients were neonates. Peak-to-peak gradient at AV was 64 ± 27 mmHg, which was reduced to 27 ± 13 mmHg. Percentage reduction was 53% ±24%. Forty-nine (82%) patients had adequate results (residual AV gradient <35 mmHg). There was no significant aortic insufficiency (AI) before procedure, while 6 (10%) patients had increased AI immediately after BAV. Of 48 patients, 14 (29%) required an additional BAV. Of 48 patients, 8 (17%) required surgical interventions following BAV. Reintervention was associated more with small left ventricular outflow tract (LVOT), high residual AV, and low percentage reduction. Mortality was 8.3%.Conclusions:BAV in infancy has a reasonable success rate (82%) with high rate of reintervention. Patent ductus arteriosus-dependent neonates carried the highest risk of mortality. Small LVOT, high AV residual gradient, and low percentage reduction resulted in more reinterventions.

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Transcatheter management of neonatal aortic stenosis

Cited by 8 publications

References 22 publications

Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle

Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle

Aortic valvuloplasty under echocardiographic guidance in a minor infant at a national referral center in Peru: case report

Percutaneous balloon dilatation for congenital aortic stenosis during infancy: A 15-year single-center experience

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