The Immediate Results of Percutaneous Balloon Aortic Valvuloplasty in Patients with Congenital Aortic Valvular Stenosis
Keywords:aortic valve disease, percutaneous balloon valvuloplasty, interventional catheterization
Objective: To assess the immediate-term effectiveness of percutaneous balloon aortic valvuloplasty (PBAV) for congenital aortic stenosis (AS).
Design: Early clinical and instrumental evaluation of 34 consecutive PBAV performed from 2001 to 2007.
Setting: A tertiary referral center for heart diseases (Ibn Al-Bitar Cardiac Center).
Patients: Thirty-four patients with congenital valvular AS, twenty-five males and nine females.
Interventions: PBAV using Tayshak balloons of different sizes and lengths.
Main outcome measures: Doppler and peak to peak pressure gradient (PG) across the aortic valve (AV) before and after valvuloplasty, the percent of PG reduction post dilatation, left ventricular (LV) systolic and diastolic pressures before and after valvuloplasty, number of the aortic cusps, degree of aortic regurgitation (AR) before and after valvuloplasty, left ventricular systolic function before and after valvuloplasty, associated anomalies, and the need for emergency surgery were the main outcome measures.
Results: The peak to peak instantaneous PG across the AV was reduced acutely from 102 ± 42.7 (20 - 200) mm Hg to 40 ± 25.5 (10- 140) mm Hg (p<0.001), left ventricular systolic pressure was reduced from 196 ± 48.57 (70 – 280) mm Hg to 133 ± 35.45 (65 – 240) mm Hg (p<0.001) and both are statistically significant. Three patients had inadequate relief of obstruction but in one of them it was mainly due to subaortic obstruction and two patients had severe AR, one of them with acute pulmonary edema and required surgical AV repair.
PBAV produced a gradient reduction ≥ 50% in 29 patients, six patients having a residual peak to peak gradient of >50 mm Hg and in one of whom the remaining PG was 70 mm Hg which was mainly subvalvular (50 mm Hg).
Six patients had bicuspid AV while the other patients had tricuspid valve. Six had associated anomalies. There was no mortality during the procedure. Severe AR reported in two patients and moderate AR occurred in five patients.
One significant complication (acute pulmonary edema) occurred immediately after the dilatation and surgery was done for that patient after few days. Two serious complications occurred during the procedure which responded to routine resuscitation.
There was a residual maximum Doppler gradient of < 30 mm Hg in 12 patients, ≥ 60 mm Hg in four (one of them had mainly subvalvular gradient) and between 30 to 48 mm Hg in the others.
Twenty one patients developed new AR (62%), in fourteen of them (41%) it was mild.
Conclusions: PBAV is an effective procedure and offers a good palliation for congenital AS.
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