Valve-sparing operation for balloon-induced aortic regurgitation in congenital aortic stenosis

Background. Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods. We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results. During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone’s syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion. Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

Download Full-text

3606 Functional anatomy of aortic regurgitation. Implications of transoesophageal echocardiographic features for valve sparing surgery

European Heart Journal ◽

10.1016/s0195-668x(03)96195-1 ◽

2003 ◽

Vol 24 (5) ◽

pp. 701

Author(s):

P GALLEGOGARCIA

Keyword(s):

Aortic Regurgitation ◽

Functional Anatomy ◽

Valve Sparing

Download Full-text

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

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.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.

Download Full-text

A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

The Heart Surgery Forum ◽

10.1532/hsf98.2013277 ◽

2014 ◽

Vol 17 (1) ◽

pp. 25 ◽

Cited By ~ 1

Author(s):

Lei Gao ◽

Qin Wu ◽

Xinhua Xu ◽

Tianli Zhao ◽

Wancun Jin ◽

...

Keyword(s):

Aortic Stenosis ◽

Transesophageal Echocardiography ◽

Severe Aortic Stenosis ◽

Ascending Aorta ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Novel Approach ◽

Low Weight ◽

Aortic Valvuloplasty ◽

Peak Gradient

Background: Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.Methods: The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.Results: The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.Conclusions: In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.

Download Full-text

Echocardiographic evaluation required for aortic valve-sparing surgery in patient with aortic regurgitation

Choonpa Igaku ◽

10.3179/jjmu.jjmu.r.117 ◽

2018 ◽

Vol 45 (4) ◽

pp. 419-428

Author(s):

Kentaro SHIBAYAMA

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Echocardiographic Evaluation ◽

Valve Sparing

Download Full-text

Faculty Opinions recommendation of Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation.

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

10.3410/f.14737.472253 ◽

2006 ◽

Author(s):

Raphael Rosenhek

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Aortic Valves

Download Full-text

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

Download Full-text

Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension

Current Vascular Pharmacology ◽

10.2174/1570161116666180101165306 ◽

2019 ◽

Vol 17 (2) ◽

pp. 180-190 ◽

Cited By ~ 3

Author(s):

V. Katsi ◽

G. Georgiopoulos ◽

D. Oikonomou ◽

C. Aggeli ◽

C. Grassos ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Regurgitation ◽

Antihypertensive Agents ◽

Renin Angiotensin System ◽

Aortic Disease ◽

Review Of The Literature ◽

Angiotensin System ◽

The Impact ◽

Worse Prognosis

Background: Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. Objective: To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. Methods: We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. Results: Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. Conclusion: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.

Download Full-text