Double-balloon aortic valvuloplasty at Queen Sirikit National Institute of Child Health.

BACKGROUND

Balloon aortic valvuloplasty is the treatment of choice in moderate and severe valvular aortic stenosis. In order to reduce the risk of vascular complications, a double-balloon technique has been used with good results.

OBJECTIVE

To present the results od double-balloon aortic valvuloplasty at QSNICH.

MATERIALS AND METHOD: Consecutive cases of severe valvular aortic stenosis treated with double-balloon aortic valvuloplasty at QSNICH were recruited in the study. Data were obtained from the medical records starting from the day of presentations to December 2011.

RESULTS

There were six cases of severe valvular aortic stenosis treated with double-balloon aortic valvuloplasty at QSNICH from 2004 to 2011. The age and weight ranged from 7 months to 12 years and 6 to 53.8 kilograms, respectively. The presenting symptoms were dyspnea in 3 (50%) and asymptomatic heart murmur in 3 cases (50%). Peak-to-peak pressure gradient (PG) before the procedure ranged from 48-104 mmHg (mean 70.00, SD 18.92 mmHg). Immediately after the procedure, PG significantly decreased to 15-52 mmHg (mean 34.33, SD 14.98 mmHg, p < 0.01). On the following day after the procedure, peak instantaneous pressure gradient (PIPG) obtained from echocardiogram ranged from 17-47 mmHg (mean 36.50, SD 10.93 mmHg). PIPG were not significantly different from PG immediately after valvuloplasty. There were two cases with partial femoral occlusion. The duration of follow-up ranged from 6-54 months (median 24 months). In the follow-up period, all of the patients were asymptomatic with functional class I. Echocardiogram after the procedure revealed no significant aortic regurgitation in any of the cases.

CONCLUSION

Double-balloon aortic valvuloplasty can be performed safely with very good intermediate term outcome in selected patients. Long-term outcome in Thai children should be further studied.