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Pediatric Cardiology

, Volume 36, Issue 3, pp 616–624 | Cite as

Balloon Dilation and Surgical Valvotomy Comparison in Non-critical Congenital Aortic Valve Stenosis

  • Sergej M. Prijic
  • Vladislav A. Vukomanovic
  • Mila S. Stajevic
  • Bojko B. Bjelakovic
  • Marija D. Zdravkovic
  • Igor N. Sehic
  • Jovan Lj. Kosutic
Original Article

Abstract

Percutaneous balloon aortic valvoplasty (BAV) and surgical aortic valvotomy (SAV) are palliative procedures in patients with non-critical congenital valve stenosis. The aim of the study was to evaluate long-term BAV and SAV results after up to 24 years of follow-up. From 1987 to 2013, 74 consecutive interventions were performed in patients with aortic stenosis, and 62 were included in the study (39 BAVs and 23 SAVs). Age of BAV patients was 1.3 months to 17 years, and of SAV patients 1.2 months to 15 years. Although BAV patients were older, there was no difference between groups according to sex, valve function/morphology, and early/late follow-up results, with exception to hospitalization period. Significant pressure gradient reduction and aortic regurgitation increment were registered after procedures. Three patients did not survive early period after surgery. Follow-up period was 7.0 ± 5.4 and 9.0 ± 8.0 years after BAV and SAV, respectively (p = 0.242). Follow-up pressure gradient rose only in the BAV group, and was emphasized after 10-year-follow-up (p = 0.020). Significant aortic insufficiency progression was registered after 15 years of follow-up in both groups (p = 0.007 and p = 0.009, respectively). Mean reintervention-free survival was 12.0 years in the BAV and 14.5 years in the SAV group (p = 0.733), and mean survival without aortic valve replacement was 15.2 and 17.4 years, respectively (p = 0.877). BAV and SAV in patients with congenital aortic stenosis are very comparable in both early and late follow-up results.

Keywords

Congenital aortic valve stenosis Balloon Surgery 

Notes

Conflict of interest

The authors declare that they have no conflict of interest. There is no financial or ethical conflict of interests regarding the contents of the submission.

References

  1. 1.
    Alexiou C, Chen Q, Langley SM, Salmon AP, Keeton BR, Haw MP, Monro JL (2001) Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southampton. Eur J Cardiothorac Surg 20:239–246CrossRefPubMedGoogle Scholar
  2. 2.
    Balmer C, Beghetti M, Fasnacht M, Friedli B, Arbenz U (2004) Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart 90:77–81CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Bauer EP, Schmidli J, Vogt PR, Von Segesser LK, Turina MI (1992) Valvotomy for isolated congenital aortic stenosis in children: prognostic factors for outcome. Thorac Cardiovasc Surg 40:334–339CrossRefPubMedGoogle Scholar
  4. 4.
    Bernstein D (2007) Aortic stenosis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds) Nelson Textbook of Pediatrics -, 18th edn. Saunders Company, Philadelphia, pp 1898–1900Google Scholar
  5. 5.
    Borghi A, Agnoletti G, Valsecchi O, Carminati M (1999) Aortic balloon dilatation for congenital aortic stenosis: report of 90 cases (1986-98). Heart 82(6):e10CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW (2003) Surgery for aortic stenosis in children: a 40-year experience. Ann Thorac Surg 76:1398–1411CrossRefPubMedGoogle Scholar
  7. 7.
    Brown DW, Dipilato AE, Chong EC, Lock JE, McElhinney DB (2010) Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis. J Am Coll Cardiol 56:1740–1749CrossRefPubMedGoogle Scholar
  8. 8.
    Brown JW, Rodefeld MD, Ruzmetov M, Eltayeb O, Yurdakok O, Turrentine MW (2012) Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg 94:146–155CrossRefPubMedGoogle Scholar
  9. 9.
    Chessa M, Carrozza M, Butera G, Negura D, Piazza L, Giamberti A, Feslova V, Bossone E, Vigna C, Carminati M (2006) The impact of interventional cardiology for the management of adults with congenital heart defects. Catheter Cardiovasc Interv 67:258–264CrossRefPubMedGoogle Scholar
  10. 10.
    Ewert P, Bertram H, Breuer J, Dahnert I, Dittrich S, Eicken A et al (2011) Balloon valvuloplasty in the treatment of congenital aortic valve stenosis - A retrospective multicenter survey of more than 1000 patients. Int J Cardiol 149:182–185CrossRefPubMedGoogle Scholar
  11. 11.
    Fratz S, Gildein HP, Balling G, Sebening W, Genz T, Eicken A, Hess J (2008) Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery: a single-center experience of 188 patients after up to 17.5 years of follow-up. Circulation 117:1201–1206CrossRefPubMedGoogle Scholar
  12. 12.
    Gatzoulis MA, Rigby ML, Shinebourne EA, Redington AN (1995) Contemporary results of balloon valvuloplasty and surgical valvotomy for congenital aortic stenosis. Arch Dis Child 73:66–69CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Holzer RJ, Cheatham JP (2010) Shifting the balance between aortic insufficiency and residual gradients after balloon aortic valvuloplasty. J Am Coll Cardiol 56:1750–1751CrossRefPubMedGoogle Scholar
  14. 14.
    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 77:1332–1338CrossRefPubMedGoogle Scholar
  15. 15.
    Karamlou T, Shen I, Alsoufia B, Burch G, Reller M, Silberbach M, Ungerleider RM (2005) The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution. Eur J Cardiothorac Surg 27:81–85CrossRefPubMedGoogle Scholar
  16. 16.
    Lababidi Z (1983) Aortic balloon valvuloplasty. Am Heart J 106:751–752CrossRefPubMedGoogle Scholar
  17. 17.
    Latiff HA, Sholler GF, Cooper S (2003) Balloon dilatation of aortic stenosis in infants younger than 6 months of age: intermediate outcome. Pediatr Cardiol 24:17–26CrossRefPubMedGoogle Scholar
  18. 18.
    Maskatia SA, Ing FF, Justino H, Crystal MA, Mullins CE, Mattamal RJ, O’Brian Smith E, Petit CJ (2011) Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis. Am J Cardiol 108:1024–1028CrossRefPubMedGoogle Scholar
  19. 19.
    Maskatia SA, Justino H, Ing FF, Crystal MA, Mattamal RJ, Petit CJ (2013) Aortic valve morphology is associated with outcomes following balloon valvuloplasty for congenital aortic stenosis. Catheter Cardiovasc Interv 81:90–95CrossRefPubMedGoogle Scholar
  20. 20.
    McCrindle BW (1996) Independent predictors of immediate results of percutaneous balloon aortic valvotomy in children. Valvuloplasty and angioplasty of congenital anomalies (VACA) registry investigators. Am J Cardiol 77:286–293CrossRefPubMedGoogle Scholar
  21. 21.
    McCrindle BW, Blackstone EH, Williams WG, Sittiwangkul R, Spray TL, Azakie A, Jonas RA (2001) Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation 104(suppl I):152–158Google Scholar
  22. 22.
    Pedra CA, 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(3):315–321CrossRefPubMedGoogle Scholar
  23. 23.
    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 of outcome. Heart 90:70–76CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Siddiqui J, Brizard CP, Galati JC, Iyengar AJ, Hutchinson D, Konstantinov IE, Wheaton GR, Ramsay JM, d’Udekem Y (2013) Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterisation. J Am Coll Cariol 62:2134–2140CrossRefGoogle Scholar
  25. 25.
    Ten Harkel AD, Berkhout M, Hop WC, Witsenburg M, Helbing WA (2009) Congenital valvular aortic stenosis: limited progression during childhood. Arch Dis Child 94:531–535CrossRefPubMedGoogle Scholar
  26. 26.
    Thomson JDR (2004) Management of valvar aortic stenosis in children. Heart 90:5–6CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sergej M. Prijic
    • 1
    • 2
  • Vladislav A. Vukomanovic
    • 1
    • 2
  • Mila S. Stajevic
    • 2
    • 3
  • Bojko B. Bjelakovic
    • 4
    • 5
  • Marija D. Zdravkovic
    • 2
    • 6
  • Igor N. Sehic
    • 3
  • Jovan Lj. Kosutic
    • 1
    • 2
  1. 1.Cardiology DepartmentMother and Child Health Institute of SerbiaBelgradeSerbia
  2. 2.School of MedicineUniversity of BelgradeBelgradeSerbia
  3. 3.Cardiothoracic Surgery DepartmentMother and Child Health Institute of SerbiaBelgradeSerbia
  4. 4.Pediatric Cardiology DepartmentClinical Center NisNisSerbia
  5. 5.School of MedicineUniversity of NisNisSerbia
  6. 6.Cardiology DepartmentUniversity Medical Center Bezanijska KosaBelgradeSerbia

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