The Purinergic Receptor (P2Y2) Agonist 2THIO-UTP Induces Regression of Aortic Valve Stenosis and Improves LV Function in Obese Diabetic Mice

Background Balloon valvuloplasty was established as an alternative to surgery for treatment of aortic valve stenosis in childhood. Acute complications after balloon dilatation including aortic insufficiency or early death were described. Aim of Work To analyze early outcome and midterm results of balloon aortic valvuloplasty (BAV) in Children's Hospital, Mansoura University, Egypt. Subjects and Methods Between April 2005–June 2008, all consecutive patients of age <18 years treated for aortic valve stenosis (AVS) with BAV were analyzed retrospectively. The study included 21 patients; 17 males, and 4 females. Their age ranged from the neonatal period to 10 years (mean age 5.6 ± 3.7 years). Patients with gradient ≥50 mmHg and aortic valve insufficiency (AI) up to grade I were included. All patients had isolated aortic valve stenosis except 3 patients (14.3%) had associated aortic coarctation. Six patients (28.6%) had bicuspid aortic valve. All patients had normal myocardial function except one (4.8%) had FS 15%. The duration of follow up was (mean ± SD: 18.5 ± 11.7 months). Results Femoral artery approach was used in 20 patients (95.2%) and carotid artery in one neonate (4.8%). Balloon/annulus ratio was 0.83 ± 0.04. Significant reduction in pressure gradient was achieved (mean 66.7 ± 9.8 mmHg to 20.65 ± 2.99 mmHg) ( P < 0.001). Nine patients (42.8%) developed grade I AI, 2 patients (9.5%) developed grade II AI and 1 patient (4.8%) developed grade III AI. Two early deaths (9.5%); one died due to heart failure caused by grade IV AI and a neonate died because of severely compromised LV function. One patient (4.8%) had femoral artery occlusion necessitating anticoagulation. Patients remained free from re-intervention during follow up. Conclusion Balloon valvuloplasty of aortic valve stenosis significantly reduces gradient with low morbidity and mortality in children.

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Aortic valve stenosis

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0012 ◽

2021 ◽

pp. 161-180

Author(s):

Philippe Pibarot ◽

Helmut Baumgartner ◽

Marie-Annick Clavel ◽

Nancy Côté ◽

Stefan Orwat

Keyword(s):

Blood Flow ◽

Aortic Valve ◽

Aortic Valve Stenosis ◽

Left Ventricular ◽

Lv Function ◽

Ageing Population ◽

Cardiac Damage ◽

Asymptomatic Patients ◽

Aortic Sclerosis ◽

Diagnostic Work

Aortic valve stenosis (AS) is the most prevalent valvular heart disease and is increasingly diagnosed in high-income countries due to an ageing population but also to more widely available diagnostic tools. The prevalence of AS is estimated at ~0.5% in the general population, ~2–3% in the population over 65 years old. This disease starts with mild fibrosis and calcification and thickening of the aortic valve leaflets without obstruction of blood flow, which is termed aortic sclerosis, and evolves over the years to severe calcification with impaired leaflet mobility and significant obstruction to blood flow, i.e. AS. The clinical presentation includes the spectrum from asymptomatic patients with different grades (mild, moderate, severe) of AS severity to symptomatic patients with severe AS who may present with preserved or already depressed left ventricular (LV) function and/or reduced transvalvular flow. Accurate assessment of the AS anatomic and haemodynamic severity as well as the extent of cardiac damage associated with AS are crucial for the therapeutic management of patients with AS. Doppler-echocardiography is the method of choice providing a comprehensive non-invasive diagnostic work-up of these patients.

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