title: Repeat balloon aortic valvuloplasty effectively delays surgical intervention in children with recurrent aortic stenosis.
abstract: OBJECTIVE
  Balloon aortic valvuloplasty (BAV) is the primary therapy for congenital aortic stenosis (AS). Recurrent AS following initial BAV or initial surgical valvotomy (SV) may require a second BAV (BAV2). We sought to determine the longterm outcomes of BAV2.
  
  
  METHODS
  We reviewed all cases of BAV2, defined as BAV following primary BAV or SV between 1988 and 2009. Cases were reviewed for pre- and post-BAV2 echocardiographic and procedural details.
  
  
  METHODS
  Tertiary care dedicated children's hospital.
  
  
  METHODS
  Between 1985 and 2009, 43 patients underwent BAV2 (23 primary SV, 20 primary BAV) at median age 1.9 years (1 month-21 years) and median weight 15 (3.3-55) kg.
  
  
  METHODS
  BAV2 performed following primary SV or primary BAV.
  
  
  METHODS
  We evaluated the following endpoints: ≥ moderate AI post-BAV2, aortic valve replacement (AVR), additional BAV or SV post-BAV2, death and heart transplantation.
  
  
  RESULTS
  The gradient decreased from 61.4 ± 16.0 mm Hg to 26.0 ± 13.6 post-BAV2 (P < 0.01). Gradient prior to BAV2 was higher in primary SV patients (66 ± 13 mm Hg) than in primary BAV patients (56 ± 18 mm Hg, P = 0.04). 24 patients had no further events after BAV2, while 19 patients (44%) experienced 23 events including: AVR (n = 8), SV (n = 6), BAV3 (n = 2), death (n = 5), and transplant (n = 1). Regression demonstrated that adverse events were associated with higher post-BAV2 gradient (P < 0.01). Repeat intervention on the aortic valve and AVR were associated with higher post BAV2 gradient (P = 0.04, P = 0.01). Prior to BAV2, 7 patients (17%) had AI > mild, compared to 21 (51%) patients after BAV2. Cox regression revealed that primary BAV was associated with development of AI > mild after BAV2 (P < 0.01).
  
  
  CONCLUSIONS
  BAV2 is associated with decreased valve gradient, though with an increase in AI. However, residual AS, not AI, is associated with poor outcomes following BAV2. BAV2 effectively treats recurrent AS and postpones need for surgical intervention.
authors: Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
authors: Christopher J
authors: CJ
authors: Petit
authors: Shiraz A
authors: SA
authors: Maskatia
authors: Henri
authors: H
authors: Justino
authors: Raphael J
authors: RJ
authors: Mattamal
authors: Matthew A
authors: MA
authors: Crystal
authors: Frank F
authors: FF
authors: Ing
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D012008:Recurrence; D019233:Retreatment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013781:Texas; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult