Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study.

Abstract

BACKGROUND:

Percutaneous balloon valvuloplasty has proven to be acutely effective in the treatment of congenital valvar aortic stenosis; however, the intermediate- and long-term effectiveness of the procedure remain to be documented.

METHODS AND RESULTS:

To assess the intermediate-term effectiveness of balloon valvuloplasty, repeat catheterization was performed in 27 of 30 children 1.7 +/- 0.1 years after balloon valvuloplasty for congenital aortic stenosis (AS). In 33 children the peak AS gradient was reduced acutely by 55% from 77 +/- 4 to 35 +/- 3 mm Hg (p less than 0.001), and left ventricular systolic pressure was reduced from 176 +/- 4 to 138 +/- 4 mm Hg (p less than 0.001). Despite a technically adequate valvuloplasty procedure, three patients had inadequate relief of obstruction and required complex surgical intervention. Twenty-seven of the 30 patients available for late reevaluation (90%) enrolled in the follow-up study. The peak AS gradient remained significantly reduced compared with that present before valvuloplasty (29 +/- 3 versus 77 +/- 4 mm Hg, p less than 0.001). Furthermore, there was no difference in peak AS gradient at follow-up compared with that immediately after valvuloplasty. The greatest increase in gradient at reevaluation was 14 mm Hg. Twenty of 27 patients (74%) had no change in the degree of aortic insufficiency at follow-up compared with that present before valvuloplasty. At follow-up, 16 patients had no aortic insufficiency at all, and only two had moderate-to-severe (3-4+) insufficiency. Femoral artery injury was documented in four patients, three of whom were under 12 months of age at valvuloplasty.

CONCLUSIONS:

Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief without early restenosis in children and adolescents with congenital AS.

• Authors: B K O'Connor, R H Beekman, A P Rocchini, A Rosenthal
• Journal: Circulation (Circulation) Vol. 84 Issue 2 Pg. 732-8 (Aug 1991) ISSN: 0009-7322 [Print] United States
• PMID: 1860218 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adolescent
• Adult
• Aortic Valve Insufficiency (etiology)
• Aortic Valve Stenosis (congenital, physiopathology, therapy)
• Cardiac Catheterization
• Catheterization (adverse effects, standards)
• Child
• Child, Preschool
• Evaluation Studies as Topic
• Femoral Artery (injuries)
• Follow-Up Studies
• Hemodynamics
• Humans
• Infant
• Prospective Studies
• Wounds, Penetrating (etiology)