Aortic valvuloplasty in congenital aortic stenosis in pediatric age

pp 92-99

Abstract

The palliative condition of the surgical valvulotomy in the congenital aortic stenosis (AoS) suggested that another therapeutical procedure as balloon catheter aortic valvuloplasty (BCAo V) will be a rational approach to. the reduction of the systolic left ventricular pressure. We perform the BCAoVin 24 patients with AoS and a 6.2 ± 5.5 years age; six of them less than one month. Through percutaneous femoral artery (n: 18), same vessel and axilary artery cut down (n: 5 and n: 2, respectively), we introduce a single (n: 22) or double (n: 2) balloon catheter with a balloon/annulus ratio about 0.92 month. Through percutaneous femoral artery (n: 18), same vessel and axilary artery cut down (n: 5 and n: 2, respectively), we introduce a single (n: 22) or double (n: 2) balloon catheter with a balloon/annulus ratio about 0.92:t 0.25 (from 0.5 to 1.2). The aortic peak to peak systolic gradient decreased from 81± 36 pre BCAoV to 31± 19 (p< 0.01) post, and the systolic left ventricular pressure diminished from 160:t45 to 121± 27 (p< 0.01). The aortic regurgitation was 0.16± 0.3 7 before and 1.04 ± O. 72 after the procedure. Two neonates were referred to surgery because of unsuccesfull result, both died in the operative room. None other mortality was registered. In 15 patients submitted to Doppler technique, the gradient before BCAoV was 94 ± 23 and 48 hours (aver- age) after it is reduced to 34± 11. We examined by Doppler echo cardiogram 10 patients whithin 6 months and 24 months of follow up; the instantaneous gradient did not show any change when is compared with the immediately after BCAoV (33 ± 9 vs 30 ± 16; NS). Our results suggest that BCAo V is an excellent alternative to surgery in the management of AoS in pediatric age 0.25 (from 0.5 to 1.2). The aortic peak to peak systolic gradient decreased from 81± 36 pre BCAoV to 31± 19 (p< 0.01) post, and the systolic left ventricular pressure diminished from 160 ± 45 to 121 ± 27 (p< 0.01). The aortic regurgitation was 0.16 ± 0.3 7 before and 1.04 ± O.72 after the procedure. Two neonates were referred to surgery because of unsuccesfull result, both died in the operative room. None other mortality was registered. In 15 patients submitted to Doppler technique, the gradient before BCAoV was 94 ± 23 and 48 hours (average) after it is reduced to 34 ± 11. We examined by Doppler echo cardiogram 10 patients whithin 6 months and 24 months of follow up; the instantaneous gradient did not show any change when is compared with the immediately after BCAoV (33:t9 vs 30:t16; NS). Our results suggest that BCAo V is an excellent alternative to surgery in the management of AoS in pediatric age.