Evaluation of initial and medium-term follow-up results of balloon aortic valvuloplasty in severe aortic valve stenosis in newborns, infants and children in Alexandria, Egypt
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20191616Keywords:
Aortic stenosis, Aortic valvuloplasty, Balloon dilatationAbstract
Background: Aortic valve stenosis (AVS) represents 3%–7% of all congenital heart diseases. Balloon aortic valvuloplasty (BAoV) has been established as an alternative to surgery for therapy of AVS in infants and children; and has proven to be an effective method for decreasing the gradient between the left ventricle and the aorta. The objective of the study was to evaluate the initial and medium-term results of BAoV in newborns, infants and children with severe AS, treated at the Alexandria University Children’s Hospital.
Methods: Thirty-seven newborns, infants and children with severe AS treated by B AoV between 2009 and 2017 were studied. They were followed-up for at least 1year post- ballooning by clinical and echocardiographic evaluation.
Results: The mean AoV annulus diameter by echo was 13.1±4.4 mm and by angiographic measurement was 12.8±4.3 mm. The mean Doppler gradient across AoV was 91.8±14.7 mmHg, compared to mean catheter gradient of 66.1±13.4 mmHg. The mean inflated balloon diameter was 12.1±4.1 mm. The mean balloon/AoV annulus ratio by angiogram was 0.94±0.03 (0.88–1). The mean pressure gradient across the AoV post-ballooning was 21.5±6.9 mmHg by Doppler and was 10.3±4.7 mmHg by catheter, both were significantly less than pre-ballooning values (p<0.001). The procedure was successful in all the cases. Only one case died. Post -ballooning aortic incompetence was moderate in 2 cases (5.4%) and severe in only one case (2.7%).
Conclusions: Balloon aortic valvuloplasty is an effective and safe technique for relieving severe aortic valvular stenosis with acceptable morbidity and minimal mortality, particularly with the new catheter and balloon technology.
References
Wolf D, Daniëls O. Management of valvar aortic stenosis in children. Pediatr Cardiol. 2002;23:375–7.
Trinkle JK, Grover FL, Arom KV. Closed aortic valvotomy in infants: Late results. J Thorac Cardiovasc Surg 1978;76:198–201.
Messina LM, Turley K, Stanger P, Hoffman JE, Ebert P. Successful aortic valvotomy for severe congenital valvular aortic stenosis in the newborn infant. J Thorac Cardiovasc Surg. 1984;88:92–6.
Sink JD, Smallhorn JF, Macartney FJ, Taylor JN, Stark J, DeLeval MR. Management of critical aortic stenosis in infancy. J Thorac Cardiovasc Surg. 1984;87:82–6.
Zeevi B, Keane JF, Castaneda AR, Perry SB, Lock JE. Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy. Circulation. 1989;80:831–9.
Lababidi Z, Wu RI, Walls TJ. Percutaneous balloon aortic valvulotomy: results in 23 patients. Am J Cardiol. 1984;53:194-7.
Kasten-Sportes CH, Piechaud JF, Sidi D, Kachaner J. Percutaneous balloon valvuloplasty in neonates with critical aortic stenosis. J Am Coll Cardiol. 1989;13:1101–5.
Wren C, Sullivan I, Bull C, Deanfield J. Percutaneous balloon dilatation of aortic valve stenosis in neonates and infants. Br Heart J. 1987;58:608–12.
Roc chini AP, Beekman RH, Ben Shachar G, Benson L, Schartz D, Kan JS. Balloon aortic valvuloplasty: results of valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol. 1990;65:784–9.
Beekman RH, Rocchini AP, Andes A. Balloon valvuloplasty for critical aortic stenosis in the newborn: Influence of new catheter technology. J Am Coll Cardiol. 1991;17:1172–6.
Moore P, Egito E, Mowrey H, Perry SB, Lock JE, Keane JF. Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol. 1996;l27:1257–63.
Justo RN, McCrindle BW, Benson LN, Williams WG, Freedom RM, Smallhorn JF. Aortic valve insufficiency after surgical versus percutaneous balloon valvotomy for congenital aortic valve stenosis. Am J Cardiol. 1996;77:1332–8.
McCrindle BW, Blackstone EH, Williams WG, Sittiwangkul R, Spray TL, Azakie A, et al. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation. 2001;104:I152–8.
McCrindle B. For the Valvoplasty, Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Independent predictors of immediate results of percutaneous balloon aortic valvotomy in childhood. Am J Cardiol. 1996;77:286–93.
Reich O, Tax P, Marek J, Rázek V, Gilík J, Tomek V, et al. Long-term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome. Heart. 2004;90:70–6.
De Giovanni JV, Edgar RA, Cranston A. Adenosine induced transient cardiac standstill in catheter interventional procedures for congenital heart disease. Heart. 1998;80:330–3.
Daehnert I, Rotzsch C, Wiener M, Schneider P. Rapid right ventricular pacing is an alternative to adenosine in catheter interventional procedures for congenital heart disease. Heart. 2004;90:1047–50.
Borghi A, Agnoletti G, Valsecchi O, Carminati M. Aortic balloon dilatation for congenital aortic stenosis: report of 90 cases (1986–98). Heart. 1999;82:e10.
Kotz S, Balakrishnan N, Read CB, Vidakovic B. Encyclopedia of statistical sciences. 2nd ed. Hoboken, NJ: Wiley-Interscience; 2006.
Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Student ed. Belmont, Calif.: Wadsworth, Cengage Learning; 2013.
Mc Lean KM, Lorts A, Pearl JM. Current treatments for congenital aortic stenosis. Curr Opin Cardiol. 2006;21:200–4.
Lofland GK, McCrindle BW, Williams WG, Blackstone EH, Tchervenkov CI, Sittiwangkul R, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. J Thorac Cardiovasc Surg. 2001;121:10–27.
Pedra CA, Sidhu R, McCrindle BW, Nykanen DG, Justo RN, Freedom RM, et al. Outcomes after balloon dilation of congenital aortic stenosis in children and adolescents. Cardiol Young. 2004;14:315–21.
Alva C, Sanchez A, David F, Jiménez S, Jiménez D, Ortegén J, et al. Percutaneous aortic valvoplasty in congenital aortic valvar stenosis. Cardiol Young. 2002;12:328–32.
Weber HS. Catheter management of aortic valve stenosis in neonates and children. Catheter Cardiovasc Interv. 2006;67:947–55.
Al Marshafawy H, Al Sawah GA, Hafez M, Matter M, El Gamal A, Sheishaa AG, et al. Balloon valvuloplasty of aortic valve stenosis in childhood: Midterm results in a Children’s Hospital, Mansoura University, Egypt. Clin Med Insights Cardiol. 2012;6:57–64.
O’Connor BK, Beekman RH, Rocchini AP, Rosenthal A. Intermediate-term effectiveness of balloon valvulotomy for congenital aortic stenosis. A prospective follow-up study. Circulation. 1991;84:732–8.
Witsenburg M, Cromme-Dijkhuis AH, Frohn-Mulder ME, Hess J. Short- and midterm results of balloon valvulotomy for valvular aortic stenosis in children. Am J Cardiol. 1992;69:945–50.
Sholler GF, Keane JF, Perry SB, Sanders SP, Lock JE. Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome. Circulation. 1988;78:351–60.
Hausdorf G, Schneider M, Schirmer KR, Schulze-Neick I, Lange PE. Antegrade balloon valvuloplasty of aortic stenosis in children. Am J Cardiol. 1993;71:460–3.
Magee AG, Nykanen D, McCrindle BW, Wax D, Freedom RM, Benson LN. Balloon dilation of severe aortic stenosis in the neonate: Comparison of antegrade and retrograde catheter approaches. J Am Coll Cardiol. 1997;30:1061–6.
Fischer DR, Ettedgui JA, Park SC, Siewers RD, del Nido PJ. Carotid artery approach for balloon dilation of aortic valve stenosis in the neonate: a preliminary report. J Am Coll Cardiol. 1990;15:1633–6.
Maeno Y, Akagi T, Hashino K, Ishii M, Sugimura T, Takagi J, et al. Carotid artery approach to balloon aortic valvuloplasty in infants with critical aortic valve stenosis. Pediatr Cardiol. 1997;18:288–91.
Weber HS, Mart CR, Kupferschmid J, Myers JL, Cyran SE. Transcarotid balloon valvuloplasty with continuous transesophageal echocardiographic guidance for neonatal critical aortic valve stenosis: An alternative to surgical palliation. Pediatr Cardiol. 1998;19:212–7.
McElhinney DB, Lock JE, Keane JF, Moran AM, Colan SD. Left heart growth, function, and reintervention after balloon aortic valvuloplasty for neonatal aortic stenosis. Circulation. 2005;111:451-8.
