Aortic balloon dilatation for congenital aortic stenosis: report of 90 cases (1986-98)

Abstract

Objective: To review 12 years of experience of balloon aortic valvoplasty in childhood.

Design: Early and mid-term clinical and instrumental evaluation of 104 consecutive balloon aortic valvoplasties performed from 1986 to 1998.

Setting: A tertiary referral centre for congenital heart disease.

Patients: 90 patients with congenital aortic stenosis: 20 neonates (group 1), 16 infants (group 2), and 54 children (group 3).

Interventions: Balloon aortic valvotomy.

Main outcome measures: Doppler and peak to peak aortic gradient before and after valvoplasty, degree of aortic regurgitation before and after valvoplasty, early and late mortality, need for repeat intervention or surgery.

Results: Balloon aortic valvoplasty produced a gradient reduction of > 50% in 59 patients, 12 having a residual peak to peak gradient of > 50 mm Hg. Early mortality included three procedure related and six procedure unrelated deaths. There were no intraprocedural deaths. Grade III aortic regurgitation occurred in 20 patients. Five non-lethal complications occurred. At a mean follow up of 5.1 (group 1), 5.7 (group 2), and 7.6 years (group 3), survival was 75%, 88%, and 96%, respectively. Redilatation was performed in three patients in group 1, one in group 2, and 10 in group 3. Surgery was necessary for six in group 1, one in group 2, and eight in group 3. Freedom from events at last follow up was 50%, 75%, and 64%, respectively. There was a residual maximum Doppler gradient of < 30 mm Hg in 22 patients and > 60 mm Hg in 23; 50 patients have mild to moderate aortic regurgitation.

Conclusions: Balloon aortic valvoplasty is effective and repeatable and offers good palliation for congenital aortic stenosis in childhood.

Figure 1

Incidence of aortic regurgitation immediately after balloon dilatation. The numbers of patients are given in the columns.

Figure 2

Survival curve in the three groups of patients.

Figure 3

Freedom from events in the three groups of patients.

Figure 4

Incidence of aortic regurgitation at late follow up. Numbers of patients are given in the columns.