[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.
Cazzaniga
M
M
Hospital de Pediatría JP Garraham, Fundación Favaloro, Buenos Aires, Argentina.
Faella
H
H
Gamboa
R
R
Kurlat
I
I
Laneri
D
D
Sciegata
A
A
Dietl
C
C
Mesz
B
B
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.