[Mid-term results of balloon percutaneous valvuloplasty in the treatment of aortic valve stenosis in children and adolescents]

Abstract

Fourteen consecutive patients aged 10.2 +/- 4.2 years with congenital valvular aortic stenosis underwent percutaneous balloon aortic valvuloplasty (PBAV) which reduced the peak-to-peak LV-aortic pressure gradient from 81.2 +/- 16.7 mmHg to 27.5 +/- 12.5 mmHg and the maximal instantaneous Doppler gradient (Dopp G) from 70.0 +/- 13.4 mmHg to 31.4 +/- 12.3 mmHg. These 14 patients were followed up 3.6 +/- 1.1 years after PBAV. Control Doppler examination showed the Dopp G (34.8 +/- 15.4 mmHg) to be comparable to that measured just after PBAV (31.4 +/- 12.3 mmHg). One patient, the only one with a mediocre, immediate result, had to be operated 5.5 years after PBAV. Aortic regurgitation was observed on aortography before PBAV in 10 patients: it remained unchanged in 7 and was aggravated in 3 patients. Aortic regurgitation was observed for the first time after PBAV in 3 patients. At control Doppler examination, aortic regurgitation was present on color Doppler in all cases but was mild or minimal in 9 cases. In one patient, secondary aggravation of aortic regurgitation required aortic valve replacement (homograft) 3 years after PBAV. Four of the 16 PBAV (25%) were performed in these 14 patients were complicated by a femoral arterial thrombosis. This study shows that the good primary results of PBAV in the treatment of congenital valvular aortic stenosis in childhood and adolescence, are maintained at medium-term. The risk of creating severe aortic regurgitation is not completely negligible but does not seem to be out of proportion compared with surgical valvotomy.