Left Ventricular Remodeling and Improvement in Diastolic Function After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis

ABSTRACT: This paper describes a case of congenital aortic stenosis with eccentric left ventricular hypertrophy associated with hypothyroidism in a 1-year-old Bourdeaux Mastiff dog. The dog had ascites, apathy, alopecic and erythematous skin lesions in different parts of the body. A two-dimensional echocardiogram revealed aortic valve stenosis, with poststenotic dilation in the ascending aorta. The same exam showed eccentric hypertrophy and dilation of the left ventricle during systole and diastole. Aortic stenosis usually results in concentric left ventricular hypertrophy instead of eccentric hypertrophy; and therefore, this finding was very unusual. Hypothyroidism, which is uncommon in young dogs, may be incriminated as the cause of ventricular dilation, making this report even more interesting. Because hypothyroidism would only result in dilatation, the eccentric hypertrophy was attributed to pressure overload caused by aortic stenosis. Thus, cardiac alterations of this case represent a paradoxical association of both diseases.

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Left Ventricular Strain Normalizes After Balloon Aortic Valvuloplasty in Infants with Congenital Aortic Stenosis

Pediatric Cardiology ◽

10.1007/s00246-020-02322-1 ◽

2020 ◽

Vol 41 (3) ◽

pp. 576-583

Author(s):

Ashish A. Ankola ◽

Michael P. DiLorenzo ◽

Mariel E. Turner ◽

Alejandro J. Torres ◽

Matthew A. Crystal ◽

...

Keyword(s):

Aortic Stenosis ◽

Left Ventricular ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Left Ventricular Strain ◽

Aortic Valvuloplasty

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Effect of balloon aortic valvuloplasty of congenital aortic stenosis in children in regression of left ventricular mass

The American Journal of Cardiology ◽

10.1016/s0002-9149(00)01540-x ◽

2001 ◽

Vol 87 (7) ◽

pp. 916-919 ◽

Cited By ~ 2

Author(s):

David Shim ◽

Erik C. Michelfelder ◽

Kim J. Lee ◽

Judy Bean

Keyword(s):

Aortic Stenosis ◽

Left Ventricular Mass ◽

Left Ventricular ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Ventricular Mass ◽

Aortic Valvuloplasty

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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.

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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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