Percutaneous balloon aortic valvuloplasty in children: early and long-term outcome.

BACKGROUND

A significant aortic stenosis in children causes hypertrophy and destructive changes of the left ventricle (LV). Definitive treatment of this condition consists of aortic valve replacement. Temporary decompression of LV may be achieved by surgical valvulotomy or percutaneous balloon valvuloplasty (PBV). The use of the latter method remains controversial.

AIM: To assess early and long-term effects of PBV of aortic stenosis in children.

METHODS

The study group consisted of consecutive 47 patients (age 4 months - 19 years, mean 8.3 years) with congenital aortic stenosis who were selected for PBV performed in a single centre.

RESULTS

PBV was performed in 46 patients and caused significant reduction of the trans-valvular pressure gradient (from 81.4+/-21.08 mmHg at baseline to 30.5+/-17.87 mmHg after PBV, p<0.0001). There were no peri-procedural deaths. One local complication occurred - damage of the femoral artery, which was treated surgically. In this patient PBV was not performed. In four patients the procedure was regarded as ineffective. During the mean follow-up of 38.4 (2-108) months there were no deaths, and eight patients underwent various types of cardiac surgery, mainly due to the progression of aortic regurgitation or lack of effects of PBV.

CONCLUSIONS

PBV is an effective palliative method for the treatment of congenital aortic stenosis. This procedure enables the delay of surgery till adulthood. Aortic regurgitation is the most common complication, and sometimes requires early surgical intervention.