Abstract
Background
Isolated aortic valve stenosis in childhood is treated by balloon valvuloplasty. The role of independent risk factors for the outcome remains unclear.
Material and methods
We analysed the early and medium term outcome of balloon valvuloplasty in isolated aortic valve stenosis in 44 pediatric patients with isolated, severe aortic valve stenosis at an age younger than 18 years, who received a primary balloon valvuloplasty during the last 5 years in our institution. We evaluated the type of aortic valve morphology, age, clinical status, and myocardial function at the time of the intervention as independent risk factor.
Results
A significant early relief of the pressure gradient across the aortic valve (P < 0.001) after balloon valvuloplasty was found. This was independent of the aortic valve morphology. Two neonates with a highly stenotic tricuspid aortic valve and severely compromised haemodynamics died within the first 30 days after the intervention. During medium term follow up (mean 22.5 months) we observed a functional deterioration for the stenosis as well as for the insufficiency of the aortic valve. “Symptoms before intervention” is an independent risk factors (P < 0.001) for valvuloplasty failure. Patients at an “age at intervention ≤ 28 days” (P = 0.02) and patients with “reduced myocardial systolic function” (P = 0.01) had a shorter time to reintervention.
Conclusions
The type of aortic valve morphology only has a weak predictive value for the outcome of balloon valvuloplasty during medium term follow up. Critical ill neonates with an impaired myocardial function are at a higher risk for valvuloplasty failure.
Similar content being viewed by others
References
Balmer C, Beghetti M, Fasnacht M, Friedli B, Arbenz U (2004) Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart 90:77–81
Demkow M, Ruzyllo W, Ksiezycka E, Szaroszyk W, Lubiszewska B, Przyluski J, Rozanski J, Wilczynski J, Hoffman P, Rydlewska-Sadowska W (1999) Long-term follow-up of balloon valvuloplasty for congenital aortic stenosis: predictors of late outcome. J Invasive Cardiol 11:227–229
Egito ES, Moore P, O’Sullivan J, Colan S, Perry SB, Lock JE, Keane JF (1997) Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm results. J Am Coll Cardiol 29:442–447
Ewert P, Bertram H, Breuer J, Dähnert I, Dittrich S, Eicken A, Emmel M, Fischer G, Gitter R, Gorenflo N, Haas N, Kitzmüller E, Koch A, Kretschmar O, Lindinger A, Michel-Behnke I, Nürnberg J, Peuster M, Walter K, Zartner P, Uhlemann F (2007) Outcome nach aortaler Ballonvalvuloplastie im Kindesalter—Analyse von mehr als 1000 Patienten aus 20 Zentren. Clin Res Cardiol 96:661 [abstract]
Feigenbaum H (1986) Aortic regurgitation. In: Echocardiography. Lea & Febiger, Philadelphia
Galal O, Rao PS, Al-Fadley F, Wilson AD (1997) Follow-up results of balloon aortic valvuloplasty in children with special reference to causes of late aortic insufficiency. Am Heart J 133:418–427
Jindal RC, Saxena A, Juneja R, Kothari SS, Shrivastava S (2000) Long-term results of balloon aortic valvulotomy for congenital aortic stenosis in children and adolescents. J Heart Valve Dis 9:623–628
Justo RN, McCrindle BW, Benson LN, Williams WG, Freedom RM, Smallhorn JF (1996) Aortic valve regurgitation after surgical versus percutaneous balloon valvotomy for congenital aortic valve stenosis. Am J Cardiol 77:1332–1338
Kuhn MA, Latson LA, Cheatham JP, Fletcher SE, Foreman C (1996) Management of pediatric patients with isolated valvar aortic stenosis by balloon aortic valvuloplasty. Cathet Cardiovasc Diagn 39:55–61
Latiff HA, Sholler GF, Cooper S (2003) Balloon dilatation of aortic stenosis in infants younger than 6 months of age: intermediate outcome. Pediatr Cardiol 24:17–26
McCrindle BW, for the Valvoplasty, angioplasty of congenital anomalies (VACA) registry investigators (1996) Independent predictors of immediate results of percutaneous balloon aortic valvotomy in childhood. Am J Cardiol 77:286–293
McCrindle BW, Blackstone EH, Williams WG, Sittiwangkul R, Spray TL, Azakie A, Jonas RA (2001) Are outcomes of surgical versus trancatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation 104:I152–158
Moore P, Egito E, Mowrey H, Perry SB, Lock JE, Keane JF (1996) Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol 27:1257–1263
Mullins CE (2006) Aortic valve dilation. In: Cardiac catheterization in congenital heart disease: pediatric and adult. Blackwell Publishing, Malden
Pedra CAC, Sidhu R, McCrindle BW, Nykanen DG, Justo RN, Freedom RM, Benson LN (2004) Outcomes after balloon dilation of congenital aortic stenosis in children and adolescents. Cardiol Young 14:315–321
Reich O, Tax P, Marek J, Razek V, Gilik J, Tomek V, Chaloupecky V, Bartakova H, Skovranek J (2004) Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors for outcome. Heart 90:70–76
Sholler GF, Keane JF, Perry SB, Sanders SP, Lock JE (1988) Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome. Circulation 78:351–360
Van Praagh R, Bano-Rodrigo A, Smolinsky A, Schuetz TJ, Fyler DX, Van Praagh S (1986) Anatomic variations in congenital valvar, subvalvar, and supravalvar aortic stenosis: a study of 64 postmortem cases. In: Takehashi M (ed) Challenges in the treatment of congenital cardiac anomalies. Futura, New York
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Knirsch, W., Berger, F., Harpes, P. et al. Balloon valvuloplasty of aortic valve stenosis in childhood: early and medium term results. Clin Res Cardiol 97, 587–593 (2008). https://doi.org/10.1007/s00392-008-0655-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-008-0655-8