721-1 Percutaneous Balloon Dilation as Initial Treatment for Critical Aortic Stenosis. Results Up to 8.3 Years Follow-up In 46 Consecutives Neonates

SummaryBalloon dilation of the aortic valve was performed in 20 consecutive neonates with critical aortic stenosis using an approach achieved by cutting down on the right carotid artery. The age of the patients ranged from one to 25 days (mean seven days) and their weight from 2.1 to 4.0 kg (mean 3.16 kg). All patients were evaluated before cardiac catheterization with cross-sectional and Doppler echocardiography so as to keep the catheterization procedure as short as possible. Balloon dilation was accomplished in all patients. The only complication was an apical perforation by the guide wire in two cases. The ensuing pericardial effusion was immediately drained with pericardiocentesis and the subsequent course of the procedure was uneventful. Immediate results showed dramatic improvement in cardiovascular conditions. The transvalvar pressure gradient fell from 80±40 to 27±20 mm Hg (p<0.001). Left ventricular ejection fraction evaluated by echocardiography increased from 30±21% before dilation to 54±18% 24-48 hours after the procedure (p<0.001). In all patients, the procedure was free from vascular complications. Aortic regurgitation was documented after the procedure in 11 patients, being severe in one, moderate in five and trivial in five. Seven patients died, although in only one was the death related directly to the procedure itself. Six patients died because of associated lesions despite an immediate satisfactory result of the balloon valvoplasty. The 13 surviving patients are doing well, and are receiving no medications. During a mean follow-up of 25 months (range 2-54 months), four patients have developed restenosis. One underwent surgical valvotomy at one year of age. The second was successfully redilated through the same approach at two months of age. The other two have a significant gradient, as assessed by Doppler measurements (60 and 70 mm Hg), with normal systolic ventricular function. Two patients have moderate aortic regurgitation. Balloon dilation achieved through cutdown on the right carotid artery is a safe and effective alternative to surgery in neonates with isolated aortic stenosis. The unfavorable results are mainly due to associated anomalies.

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Criteria for selection of balloon valvoplasty for treatment of aortic stenosis in neonates

Cardiology in the Young ◽

10.1017/s1047951100011422 ◽

1995 ◽

Vol 5 (1) ◽

pp. 31-35 ◽

Cited By ~ 5

Author(s):

Andrea Donti ◽

Marco Bonvicini ◽

Gaetano Gargiulo ◽

Guido Frascaroli ◽

Fernando M. Picchio

Keyword(s):

Aortic Stenosis ◽

Aortic Root ◽

Clinical Success ◽

Balloon Dilation ◽

Left Ventricular ◽

Critical Aortic Stenosis ◽

Anatomical Features ◽

Echocardiographic Parameters ◽

Predicting Outcome

SummaryIn 10 neonates with critical aortic stenosis who were treated with balloon dilation, we investigated retrospectively the predictive value for mortality of three echocardiographic parameters: early diastolic mitral valvar diameter, left ventricular end-diastolic diameter, and diameter of the aortic root. Valvoplasty was technically successful in each patient and the peak systolic ejection gradient decreased from 85±42 to 22±13 mm Hg, but clinical success was achieved in only six neonates, with four dying. The diameter of the aortic root was similar in survivors and non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The association of a mitral valvar diameter equal to, or less than, 9 mm with a left ventricular end-diastolic diameter equal to, or less than, 14 mm identified clearly all those who did not survive. In the future, we will recommend patients with these anatomical features for primary Norwood palliation. Neonates with a mitral valvar diameter equal to or greater than 12 mm and a left ventricular end-diastolic diameter equal to or greater than 17 mm, in contrast, are good candidates for balloon dilation. All our patients with these anatomical features survived and are doing well at follow-up (30±14.8 months). Simple echocardiographic measurements, therefore, can help in predicting outcome and choosing the best treatment in neonates with critical aortic stenosis.

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Percutaneous Balloon Valvuloplasty of Both Pulmonary and Aortic Valves in a Neonate with Pulmonary Atresia and Critical Aortic Stenosis

Pediatric Cardiology ◽

10.1007/s00246-005-0862-2 ◽

2005 ◽

Vol 26 (6) ◽

pp. 839-842 ◽

Cited By ~ 3

Author(s):

T. Kobayashi ◽

N. Momoi ◽

Y. Fukuda ◽

H. Suzuki

Keyword(s):

Aortic Stenosis ◽

Pulmonary Atresia ◽

Balloon Valvuloplasty ◽

Aortic Valves ◽

Critical Aortic Stenosis ◽

Percutaneous Balloon ◽

Percutaneous Balloon Valvuloplasty

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Emergency Percutaneous Balloon Aortic Valvuloplasty in Critical Aortic Stenosis with Hemodynamic Instability

Revista Brasileira de Cardiologia Invasiva (English Edition) ◽

10.1016/s2214-1235(15)30148-4 ◽

2013 ◽

Vol 21 (3) ◽

pp. 295-298

Author(s):

Roberto Ramos Barbosa ◽

Renato Giestas Serpa ◽

Roberto de Almeida Cesar ◽

Darlan Dadalt ◽

Felipe Bortot Cesar ◽

...

Keyword(s):

Aortic Stenosis ◽

Hemodynamic Instability ◽

Balloon Aortic Valvuloplasty ◽

Critical Aortic Stenosis ◽

Percutaneous Balloon ◽

Aortic Valvuloplasty

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The Immediate And Intermediate Results Of Percutaneous Balloon Aortic Valvuloplasty In Patients With Congenital Valvular Aortic Stenosis

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v13i2.94 ◽

2019 ◽

Vol 13 (2) ◽

pp. 51-55

Author(s):

Hussein A. Alwahab

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Pressure Gradient ◽

Aortic Regurgitation ◽

Balloon Aortic Valvuloplasty ◽

Maximum Peak ◽

Percutaneous Balloon ◽

Aortic Valvuloplasty ◽

Valvular Aortic Stenosis

Background: Aortic valve stenosis results from minor to severe degrees of aortic valve maldevelopment. This stenosis causes mild to severe obstruction of the left ventricular outflow . Objectives : to study the immediate and intermediate results of percutaneous balloon aortic valvuloplasty in patients with congenital valvular aortic stenosis . Type of the study: A prospective study. Methods: The study was done on thirty five patients with congenital valvular aortic stenosis who had percutaneous balloon aortic valvuloplasty in Ibn Al- Bitar Center for Cardiac Surgery from May 2009 to February 2011. Results: Twenty seven patients were male (77.2%) and 8 patients were female (22.8%), male to female ratio 3.5/ 1, . The aortic valve was bicuspid in 18 patients (51.4%) while 17 patients ( 48.6%) had tricuspid aortic valve. Balloon aortic valvuloplasty was successful in 30 patients (85.7%),. Maximum peak instantaneous Doppler pressure gradient across the aortic valve 24 hours postprocedural echocardiography showed reduction which is statistically significant. New aortic regurgitation had occurred in 15 patients ( 42.8%), it was mild in 9 patients ( 25.6%), moderate in 5 patients ( 14.3%) and severe in 1 patient( 2.9%) which is statistically significant. The follow up of 12.57 ± 3.88 ( 3- 22) months after intervention was done for all patients using echocardiography Doppler study, reveal the maximum peak instantaneous Doppler pressure gradient across the aortic valve was raised which is statistically significant. The aortic regurgitation was present in 18 patients (51.4%) , it was mild in 9 patients (25.7%) , moderate in 6 patients (17.1%) and severe in 3 patients ( 8.6%). No mortality had been reported during the procedure or on follow up. Conclusion: Aortic balloon valvuloplasty is safe and effective procedure in the treatment of congenital valvular aortic stenosis but mild aortic regurgitation is the most common immediate complication of aortic balloon dilatation and progressive aortic regurgitation is a major problem during the intermediate follow up.

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Percutaneous Balloon Valvuloplasty for Critical Aortic Stenosis: A Bridge to Safer Noncardiac Surgical Procedures

Mayo Clinic Proceedings ◽

10.1016/s0025-6196(12)61763-7 ◽

1989 ◽

Vol 64 (7) ◽

pp. 871-873 ◽

Cited By ~ 2

Author(s):

Eric R. Powers

Keyword(s):

Aortic Stenosis ◽

Surgical Procedures ◽

Balloon Valvuloplasty ◽

Critical Aortic Stenosis ◽

Percutaneous Balloon ◽

Percutaneous Balloon Valvuloplasty

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Follow-up after percutaneous balloon valvoplasty for noncalcific aortic stenosis

The American Journal of Cardiology ◽

10.1016/0002-9149(90)90095-i ◽

1990 ◽

Vol 65 (3) ◽

pp. 250-252 ◽

Cited By ~ 8

Author(s):

Savitri Shrivastava ◽

Gladwin S. Das ◽

Vishva Dev ◽

Sanjeev Sharma ◽

Mira Rajani

Keyword(s):

Aortic Stenosis ◽

Percutaneous Balloon

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Successful biventricular repair following in-utero balloon dilation of critical aortic stenosis

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/s-2005-923308 ◽

2005 ◽

Vol 209 (S 2) ◽

Author(s):

G Tulzer ◽

W Arzt ◽

R Mair ◽

E Lechner ◽

G Geiselseder

Keyword(s):

Aortic Stenosis ◽

Balloon Dilation ◽

In Utero ◽

Biventricular Repair ◽

Critical Aortic Stenosis

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A national study of the outcome after treatment of critical aortic stenosis in the neonate

Cardiology in the Young ◽

10.1017/s1047951120002036 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1321-1327

Author(s):

Cecilia Kjellberg Olofsson ◽

Katarina Hanseus ◽

Jens Johansson Ramgren ◽

Mats Johansson Synnergren ◽

Jan Sunnegårdh

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

National Study ◽

Term Survival ◽

Critical Aortic Stenosis

AbstractObjective:This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention.Methods:All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement.Results:Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%).Conclusions:Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

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