Aortic valve morphology is associated with outcomes following balloon valvuloplasty for congenital aortic stenosis: Reflection on morphological retrospection aids selection for interventional rejection

Introduction. Balloon valvuloplasty (BVP) is one of the primary therapies for congenital aortic stenosis in children and adolescents. The aim of this interventional procedure is to gain time before possible surgical therapy (aortic valve replacement) until adulthood. Objective. The aim of this study was to evaluate the efficacy, safety and mid-term results of transcatheter BVP in children and adolescent in our Center. Methods. From 2004 to 2011, 50 patients, aged 18 days to 18 years (mean 6.3 years) underwent BVP. Retrospective analysis of the echocardiographic and hemodynamic parameters were performed before and after procedure, especially peak pressure gradient (PG) across the aortic valve, semiquantification of the aortic regurgitation (AR) after the BVP as well as the left ventricle dimensions and functions. Results. The mean peak PG in the whole group decreased from 74.80?27.72 mm Hg to 27.86?13.04 mm Hg (p<0.001) after BVP. In 39 patients (78%), residual PG was lower than 30 mm Hg just after dilation. At the end of follow-up period, 25 patients (50%) had PG above 50 mm Hg, measured by Doppler technique, and four of them underwent re-dilation. Eight patients (16%) had severe AR. During the follow-up period (12-80 months, mean 51 months), six patients (12%) were referred to cardiac surgeons for aortic valve replacement or Ross procedure. Conclusions. This retrospective study analyzes our first experience of BVP as primary therapy of the congenital aortic stenosis. The results confirmed that BVP effectively postponed the need for surgery in children and adolescents toward the adulthood.

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Freedom from aortic valve replacement in pediatric patients with congenital aortic stenosis after initial balloon valvuloplasty versus operative commissurotomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2006-925680 ◽

2006 ◽

Vol 54 (S 1) ◽

Author(s):

B Nasseri ◽

H Abdul-Khaliq ◽

M Zimmer ◽

M Hübler ◽

V Alexi-Meskishvili ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Pediatric Patients ◽

Balloon Valvuloplasty ◽

Congenital Aortic Stenosis

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The Ross-Konno Procedure as Reoperative Treatment in a Young Adult with Congenital Aortic Stenosis

The Heart Surgery Forum ◽

10.1532/hsf98.20111091 ◽

2012 ◽

Vol 15 (4) ◽

pp. 182

Author(s):

Fotios A. Mitropoulos ◽

Meletios A. Kanakis ◽

Sotiria C. Apostolopoulou ◽

Spyridon Rammos ◽

Constantine E. Anagnostopoulos

Keyword(s):

Young Adult ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Young Patients ◽

Uneventful Recovery ◽

Ross Procedure ◽

Congenital Aortic Stenosis ◽

Biological Prostheses

<p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.</p><p>We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.</p>

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Faculty Opinions recommendation of Sudden unexpected death after balloon valvuloplasty for congenital aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8343956.8782055 ◽

2011 ◽

Author(s):

Larry Latson ◽

Athar Qureshi

Keyword(s):

Aortic Stenosis ◽

Sudden Unexpected Death ◽

Balloon Valvuloplasty ◽

Unexpected Death ◽

Congenital Aortic Stenosis

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Abstract 19440: Reintervention Rates Following Balloon Aortic Valvuloplasty versus Surgical Valve Repair in Isolated Congenital Aortic Valve Stenosis - A Meta-analysis

Circulation ◽

10.1161/circ.132.suppl_3.19440 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

May T Saung ◽

Courtney McCracken ◽

Ritu Sachdeva ◽

Christopher J Petit

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Stenosis ◽

Meta Analysis ◽

Valve Repair ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Primary Indication ◽

Aortic Valvuloplasty

Introduction: The optimal treatment for congenital aortic stenosis (AS) is debated despite decades of experience with both balloon aortic valvuloplasty (BAV) and surgical aortic valve repair (SAV). While BAV has been the mainstay of therapy for AS, recent single-center reports suggest optimal results following SAV. Hypothesis: We propose that reintervention rates following SAV and BAV are equivalent. Methods: We queried Medline, EMBASE and Web of Science for eligible studies using the keywords: “congenital aortic stenosis”, “balloon valvotomy”, “aortic valve stenosis surgery” and “treatment outcome or reintervention”. Studies were excluded when cohort size was <20 pts, when follow-up was < 2.5 yrs from primary intervention, and when primary indication was not AS (e.g. SAV in the setting of aortic valve regurgitation (AR)). Outcomes analyzed included death, reintervention and moderate or severe AR. Analysis was performed using Comprehensive Meta Analysis v3 using random effects models. Results: A total of 20 studies were included in our meta-analysis: SAV alone (n=3), BAV alone (n=12), and both (n=5). The mean age at BAV was 3.1 years (range, 4 days - 7 years) with a mean follow-up duration of 6.8 years, while mean age at SAV was 2.8 years (range, 14.2 days - 7.1 years) with a mean follow-up duration of 9.1 years. Mortality rates following BAV and SAV were 12.3% (95% CI: 7.7 - 19.1) and 10.2% (95% CI: 7.0 - 14.5), respectively (p=0.27). Reintervention following initial procedure for treatment of AS was higher following BAV (35.7% [95% CI: 29 - 43.1]) compared to SAV (25.2% [95% CI: 19.9 - 31.3])(p=0.012). Long-term and mid-term follow-up in these studies showed moderate to severe AR was present in 24.1% and 28.1% of BAV and SAV patients, respectively. Conclusions: Notwithstanding publication bias, both survival rates and development of late AR following BAV and SAV are similar. However, reintervention rates are significantly higher following BAV compared to SAV.

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