[Percutaneous balloon valvotomy in neonatal obstructive cardiopathy. II. Critical aortic valve stenosis].
Percutaneous balloon aortic valvotomy using one or more balloons in sequential approach was attempted in 11 non selected neonates with critical aortic valve stenosis. The procedure was complete in 9 (81%), and they represent the study group with a mean age of 19 days. Using a balloon/annulus ratio of 0.86, the transvalvar gradient decreased from 49 to 25 mmHg, and left ventricular systolic pressure fell from 112 mmHg to 96 mmHg (p < 0.01, respectively). Fifty-five percent (5/9) of the patients developed a new aortic regurgitation, only one with grade 3. The maximal instantaneous Doppler gradient recorded in 7 neonates before and after valvotomy dropped from 67 to 35 mmHg (p < 0.01); while the left ventricular shortening fraction increased from 15 to 31% (p < 0.01). The Doppler gradient was correlated with the left ventricular shortening fraction (r:0.72) and the aortic regurgitation with the balloon/annulus ratio (r:0.82). The balloon pulmonary valvotomy was unsuccessful in 2 neonates (22%), both with hypoplastic left ventricle, both of which died in the operating room. Echocardiographic features of reestenosis were not found in the follow-up period (14 +/- 10 months); only one patient may need a future surgical intervention because significant aortic insufficiency. The pulmonary balloon valvotomy is a safe and effective therapy that must be used as the first step in the management of neonates with critical aortic stenosis in absence of hypoplastic left ventricle.
Hospital de Pediatría JP Garraham, Fundación Favaloro, Buenos Aires, Argentina.
M
M
Cazzaniga
H
H
Faella
R
R
Gamboa
I
I
Kurlat
D
D
Laneri
A
A
Sciegata
C
C
Dietl
B
B
Mesz
D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D002404:Catheterization; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D012770:Shock, Cardiogenic / Q000517:prevention & control; D013030:Spain
Valvotomía percutánea con balón en la cardiopatía obstructiva neonatal. Parte II: Estenosis valvular aórtica crítica.