title: Repeat balloon dilation of congenital valvar aortic stenosis: immediate results and midterm outcome.
abstract: While balloon dilation (BD) has become the initial treatment for congenital valvar aortic stenosis (CVAS) at many institutions, repeat BD for recurrent obstruction has been reported only in a few. Between January 1985 and December 1996, 298 patients (70 neonates) underwent BD, 34 of whom underwent a repeat BD without mortality. A greater proportion of neonates had a repeat BD (26% vs. 8%, P < 0.001). At repeat BD (1 day-7.5 years post initial BD), the mean peak-to-peak gradient was reduced from 67+/-24 to 36+/-16 mm Hg (P < 0.0001). Aortic regurgitation (AR) increased immediately in 26%, being moderate or more in 24%. During a mean follow-up of 5.2 years, there was one surgically related death. Of the 33 survivors, 6 had surgery for residual stenosis and/or AR. Among the remaining 27 patients, 96% were asymptomatic, the peak instantaneous aortic valve Doppler gradient was 50+/-15 mm Hg with AR absent in 8%, mild in 62%, and moderate or more in 31%. In conclusion, repeat BD is effective and without mortality. AR was at least moderate in 24% of patients immediately after a second BD. Repeat BD was more common in patients who underwent the initial BD as neonates.
authors.affiliation: Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Satou
authors.forename: S B
authors.initials: SB
authors.lastname: Perry
authors.forename: J E
authors.initials: JE
authors.lastname: Lock
authors.forename: G E
authors.initials: GE
authors.lastname: Piercey
authors.forename: J F
authors.initials: JF
authors.lastname: Keane
mesh_terms: D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000628:therapy*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019233:Retreatment; D016896:Treatment Outcome