Percutaneous transluminal balloon valvuloplasty and balloon angioplasty in congenital heart defects with left heart obstruction in childhood
Stein, J.I.; Beitzke, A.; Suppan, C.; Lammer, J.; Fall, A.
Wiener Klinische Wochenschrift 102(16): 479-486
1990
ISSN/ISBN: 0043-5325 PMID: 2145701 Document Number: 359097
Balloon dilation was performed in 31 patients with congenital left heart obstructions. In 16 patients with aortic stenosis aged 2 days to 16.3 years (mean 10.03 +/- 4.79 years) the peak systolic gradient decreased significantly from 80 +/- 21 mmHg to 23 +/- 13 mmHg immediately after dilation, and remained low at the time of follow up (6 months to 3 years), namely 30 +/- 12 mmHg (p less than 0.0001). Mild aortic regurgitation (I degrees) was already present before the procedure in 56%, increased in 3 patients, and reached haemodynamic significance in 1 (III degrees). Half of the 14 patients with coarctation, aged 2 months to 16.75 years (mean 4.98 +/- 5.15 years), had undergone previous surgery 2 months to 7.9 years before the balloon dilation; coarctation was native in the remainder. Peak systolic gradient across the coarctation site was reduced from 46 +/- 10 mmHg to 5 +/- 5 mmHg, and was 9 +/- 7 mmHg at the time of follow up (6 months-3.6 years) (p less than 0.0001). Aneurysms were not detected. In a 6-year-old girl with congenital mitral stenosis the gradient fell from 13 mmHg to 7 mmHg immediately after the procedure. There were no serious complications. Peripheral arterial lesions required medical or surgical treatment in 16% of cases. Our report suggests that balloon valvuloplasty and angioplasty is a safe and well-tolerated procedure in childhood. It can reduce the gradient in congenital left heart obstructions with good short-term and intermediate-term results.