Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-27T06:38:21.607Z Has data issue: false hasContentIssue false

Percutaneous aortic valvoplasty in congenital aortic valvar stenosis

Published online by Cambridge University Press:  30 July 2009

Carlos Alva*
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
Agusím Sánchez
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
Felipe David
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
Santiago Jiménez
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
David Jiménez
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
José Ortegón
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
Martha Hernández
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
José Antonio Magaña
Affiliation:
Congenital Heart Disease Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
Rubén Argüero
Affiliation:
Director, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
Mariano Ledesma
Affiliation:
Interventionist, Cardiology Department, Hospital de Cardiología, National Medical Centre Siglo, XXI, Mexico City, Mexico
*
Servicio de Cardiopatías Congénitas, Hospital de Cardiología, National Medical Centre Siglo, XXI, Av. Cuauhtemoc 330, Col. Doctores, Mexico City, Distrito Federal, CP 06721. Tel: 52 5627 6900 ext. 2500; Fax: 52 5761 4867; E-mail: alval@prodigy.net.mx

Abstract

Objective: To evaluate immediate and midterm results with percutaneous aortic valvoplasty. Material and Methods: We reviewed the records of 141 patients undergoing percutaneous aortic valvopasty over a period of 13 years. Results: The patients were aged from 2 months to 40 years, with a mean of 10.9 ± 9.9 years. Of the total, 90 (63%) were male. The initial systolic peak-to-peak gradient decreased from 163 ± 52 mmHg to 32 ± 18 mmHg (p > 0.01) after valvoplasty in all 141 patients, while the proportional reduction ranged from 0 to 100%, with a mean of 72 ± 27%. The index of the size of the balloon to the diameter of the valvar orifice was 0.88 ± 0.19 in 128 patients. The follow-up ranged from 6 to 168 months, with a mean 51 ± 48 months in 70 patients. A significant difference was found in those failing after dilation when the initial evaluation was compared to the final evaluation of patients with follow-up. In those failing, the number of patients rose from 12 (17%) to 21 (30%) (p > 0.01). In contrast, in those in whom we achieved success, there was not such a great difference between the initial and final evaluation: 58 (83%) versus 49 (70%) (p > 0.1). The actuarial freedom curve of patients not needing new percutaneous aortic valvoplasty or surgery, by 182 months, was at 87% and 82% respectively. Conclusion: We have reviewed the largest series of patients in Latin-America reported thus far after undergoing percutaneous aortic valvoplasty, concentrating on mid term follow-up and limitations. New prospective and multicentric studies are needed from our region.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lababidi, Z.Aortic balloon valvuloplasty. Am Heart J 1983; 106: 751752.CrossRefGoogle ScholarPubMed
2.Rocchini, AP, Beekman, RH, Shachar, GB, Benson, L, Schwartz, D, Kan, JS.Balloon aortic valvuloplasty results and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 784789.CrossRefGoogle ScholarPubMed
3.O'Connor, BK, Beekman, RH, Rocchini, AP, Rosenthal, A.Intermediate term effectiveness of balloon valvuloplasty for congenital aortic stenosis: prospective follow-up study. Circulation 1991; 84: 732738.CrossRefGoogle ScholarPubMed
4.Shaddy, RE, Boucek, MM, Sturterant, JE, Ruttenberg, HD, Orsmand, GS.Gradient reduction, aortic valve regurgitation and prolapse after balloon aortic valvuloplasty in 32 consecutive patients with congenital aortic stenosis. J Am Coll Cardiol 1990; 16: 451456.CrossRefGoogle ScholarPubMed
5.Vogel, M, Benson, LN, Burrows, P, Smallborn, J, Freedom, RM.Balloon dilatation of congenital aortic valve stenosis in infants and children: short term and intermediate results. Br Heart J 1989; 63:148153.CrossRefGoogle Scholar
6.Moore, P, Egito, E, Mowrey, H, Perry, SB, Lock, JE, Keane, JF.Midterm results of balloon dilatation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol 1996; 27: 12571268.CrossRefGoogle ScholarPubMed
7.Galal, O, Rao, PS, Fadel, Al-Fadley, Wilson, AD.Follow-up results balloon aortic valvuloplasty in children with special reference the causes of late aortic insufficiency. Am Heart J 1996; 133: 418427.CrossRefGoogle Scholar
8.Egito, ES, Moore, P, O'Sullivan, J et al. , Transvalvular balloon dilation for neonatal critical aortic stenosis: early and midterm results. J Am Coll Cardiol 1997; 29: 442447.CrossRefGoogle Scholar
9.Shim, D, Lloyd, TR, Beekman, RH III., Usefulness of repeat balloon aortic valvuloplasty in children. Am J Cardiol 1997; 79: 11411143.CrossRefGoogle ScholarPubMed
10.Brian, MW.Independent predictors of immediate results of percutaneous balloon aortic valvulotomy in childhood. Am J Cardiol 1996; 77: 286293.Google Scholar
11.Robinson, BV, Brzezinska-Rajszys, G, Weber, HS et al. , Balloon aortic valvuloplasty through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry. Cardiol Young 2000; 10: 225232.CrossRefGoogle Scholar
12.Dolan, MS, Catello, R, St Vrain, JA, Agirre, F, Labovitz, AJ.Quantization of aortic regurgitation by Doppler echocardiography: a practical approach. Am Heart J 1995; 129: 10141020.CrossRefGoogle Scholar
13.Wren, C, Sullivan, I, Bull, C, Deanfield, J.Percutaneous balloon dilation of aortic valve stenosis in neonates and infants. Br Heart J 1987; 58: 608612.CrossRefGoogle ScholarPubMed
14.Rao, PS, Thapar, MK, Wilson, AD, Levy, JM, Chopra, PS.Intermediate term follow-up results of balloon aortic valvuloplasty in infants and children with special reference to causes of restenosis. Am J Cardiol 1989; 64: 13561360.CrossRefGoogle ScholarPubMed
15.McCrindle, BW, Brian, W.Independent predictors of immediate results of percutaneous balloon aortic valvulotomy in childhood. Am J Cardiol 1996; 77: 286293.CrossRefGoogle Scholar
16.Justo, RN, McCrindle, B, Benson, LN, Williams, WG, Freedom, RM, Smallhorn, JF.Aortic valve regurgitation after surgical versus percutaneous balloon valvotomy for congenital aortic valve stenosis. Am J Cardiol 1996; 77: 13321338.CrossRefGoogle ScholarPubMed
17.Solymar, L, Sudow, G, Berggren, H, Eriksson, B.Balloon dilatation of stenotic aortic valve in children: an intra operative study. J Thorac Cardiovasc Surg 1992; 104: 17091713.CrossRefGoogle Scholar
18.Fischer, DR, Ettedegui, JA, Park, SC, Siewers, RD, del Nido, P.Carotid approach for balloon dilatation of aortic valve stenosis in the neonate: a preliminary report. Am J Cardiol 1990; 15: 16331636.CrossRefGoogle ScholarPubMed
19.O'Laughlin, MP, Slack, MC, Grifka, R, Mullins, CE.Prograde double balloon dilation of congenital aortic valve stenosis: a case report. Cathet Cardiovasc Diagn 1993; 28: 134136.CrossRefGoogle ScholarPubMed
20.Hausdorf, G, Schneider, M, Schirmer, KR, Schulze-Neick, J, Lange, PE.Antegrade balloon valvuloplasty of aortic stenosis in children. Am J Cardiol 1993; 71: 460462.CrossRefGoogle Scholar
21.Chartrand, CC, Saro-Serrando, E, Vobecky, JS.Long term results of surgical valvuloplasty for congenital valvar aortic stenosis in children. Ann Thorac Surg 1999; 68: 13561360.CrossRefGoogle ScholarPubMed
22.Lambert, V, Obreja, D, Losay, J et al. , Long-term results after valvulotomy for congenital aortic valvar stenosis in children. Cardiol Young 2000; 10: 590596.CrossRefGoogle Scholar