Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study.
BACKGROUND
Percutaneous balloon valvuloplasty has proven to be acutely effective in the treatment of congenital valvar aortic stenosis; however, the intermediate- and long-term effectiveness of the procedure remain to be documented.


RESULTS
To assess the intermediate-term effectiveness of balloon valvuloplasty, repeat catheterization was performed in 27 of 30 children 1.7 +/- 0.1 years after balloon valvuloplasty for congenital aortic stenosis (AS). In 33 children the peak AS gradient was reduced acutely by 55% from 77 +/- 4 to 35 +/- 3 mm Hg (p less than 0.001), and left ventricular systolic pressure was reduced from 176 +/- 4 to 138 +/- 4 mm Hg (p less than 0.001). Despite a technically adequate valvuloplasty procedure, three patients had inadequate relief of obstruction and required complex surgical intervention. Twenty-seven of the 30 patients available for late reevaluation (90%) enrolled in the follow-up study. The peak AS gradient remained significantly reduced compared with that present before valvuloplasty (29 +/- 3 versus 77 +/- 4 mm Hg, p less than 0.001). Furthermore, there was no difference in peak AS gradient at follow-up compared with that immediately after valvuloplasty. The greatest increase in gradient at reevaluation was 14 mm Hg. Twenty of 27 patients (74%) had no change in the degree of aortic insufficiency at follow-up compared with that present before valvuloplasty. At follow-up, 16 patients had no aortic insufficiency at all, and only two had moderate-to-severe (3-4+) insufficiency. Femoral artery injury was documented in four patients, three of whom were under 12 months of age at valvuloplasty.


CONCLUSIONS
Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief without early restenosis in children and adolescents with congenital AS.
O'Connor
B K
BK
Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI 48109-0204.
Beekman
R H
RH
Rocchini
A P
AP
Rosenthal
A
A
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization; D002404:Catheterization / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005263:Femoral Artery / Q000293:injuries; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D014950:Wounds, Penetrating / Q000209:etiology