Intermediate results of balloon valvuloplasty in children with congenital aortic valve stenosis
Friedli, B.; Meier, B.; Oberhansli, I.
Schweizerische Medizinische Wochenschrift 120(45): 1681-1686
1990
ISSN/ISBN: 0036-7672 PMID: 2251485 Document Number: 354694
Eleven children with aortic valve stenosis requiring treatment underwent percutaneous balloon valvuloplasty instead of surgery. Three were newborns or infants and 8 were aged 2-18 years. Aortic valve gradient was 45-160 mm Hg (mean 83 mm Hg) before valvuloplasty; after the procedure the gradients ranged from 7-43 mm Hg (mean 25). One newborn with critical stenosis and associated left ventricular fibroelastosis died 48 hours after valvuloplasty. All others showed marked clinical improvement after the procedure. Main complications included permanent loss of peripheral pulses in the catheterized leg (2 cases, age 2 months and 20 months) and aortic valve regurgitation. This was estimated as moderate (++) in 2 and moderately severe (3+) in one; it was minimal or absent in the others. All patients were followed up for 3 months to 4 years. There was one recurrence of aortic stenosis, 2 years after valvuloplasty, requiring surgery. Two infants also underwent late surgery after successful valvuloplasty, one for mitral valve replacement and one for severe subvalvular aortic stenosis. In the remaining seven children the good initial result was maintained. Aortic valve gradient was estimated with Doppler at regular intervals and did not increase significantly over the follow-up period. In conclusion, balloon valvuloplasty is an alternative to open heart surgery in aortic valve stenosis in the young; both procedures are palliative.