Background The goal of this study was to evaluate long-term results of percutaneous balloon valvuloplasty (BVPL) used exclusively for initial management of congenital aortic stenosis in children. Methods and Results A total of 409 consecutive pediatric patients (134 newborns, 275 older patients) who underwent BVPL as initial treatment of aortic stenosis in a single nationwide pediatric center were subjected to a retrospective follow-up study. The resulting follow-up time reached a median of 18.5 (interquartile range, 12.2-25.1) years. Successful BVPL was defined by residual Doppler gradient <70/40 (systolic/mean) mm Hg. The primary end point was death; secondary end points included any valve reintervention, balloon revalvuloplasty, any aortic valve surgery, and aortic valve replacement, respectively. BVPL effectively reduced the peak and mean gradient both immediately and at the latest follow-up (P<0.001). There was significant procedure-related progression of aortic insufficiency (P<0.001). Higher aortic annulus z score was predictive for severe aortic regurgitation (P<0.05) and lower z score for insufficient gradient reduction (P<0.05). The actuarial probability of survival/survival free from any valve reintervention was 89.9%/59.9%, 85.9%/35.2%, and 82.0%/26.7% at 10, 20, and 30 years after first BVPL, respectively. Left ventricular dysfunction or arterial duct dependency as the indication for BVPL was predictive of both worse survival and survival free from any reintervention (P<0.001). Lower aortic annulus z score and lower balloon-to-annulus ratio were predictive of a need for revalvuloplasty (P<0.001). Conclusions Percutaneous BVPL provides good initial palliation. In patients with hypoplastic annuli and left ventricular or mitral valve comorbidity, the results are less favorable.

Children's Heart Centre 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Zobrazit více v PubMed

Lababidi Z. Aortic balloon valvuloplasty. Am Heart J. 1983;106:751–752. doi: 10.1016/0002-8703(83)90097-2 PubMed DOI

Lababidi Z, Wu JR, Walls JT. Percutaneous balloon aortic valvuloplasty: results in 23 patients. Am J Cardiol. 1984;53:194–197. doi: 10.1016/0002-9149(84)90709-4 PubMed DOI

Lababidi Z, Weinhaus L. Successful balloon valvuloplasty for neonatal critical aortic stenosis. Am Heart J. 1986;112:913–916. doi: 10.1016/0002-8703(86)90299-1 PubMed DOI

Galal O, Rao PS, Al‐Fadley F, Wilson AD. Follow‐up results of balloon aortic valvuloplasty in children with special reference to causes of late aortic insufficiency. Am Heart J. 1997;133:418–427. doi: 10.1016/S0002-8703(97)70183-2 PubMed DOI

Gaynor JW, Bull C, Sullivan ID, Armstrong BE, Deanfield JE, Taylor JF, Rees PG, Ungerleider RM, de Leval MR, Stark J. Late outcome of survivors of intervention for neonatal aortic valve stenosis. Ann Thorac Surg. 1995;60:122–125; discussion 125–6. doi: 10.1016/S0003-4975(95)00384-3 PubMed DOI

Gatzoulis MA, Rigby ML, Shinebourne EA, Redington AN. Contemporary results of balloon valvuloplasty and surgical valvotomy for congenital aortic stenosis. Arch Dis Child. 1995;73:66–69. doi: 10.1136/adc.73.1.66 PubMed DOI PMC

Mosca RS, Iannettoni MD, Schwartz SM, Ludomirsky A, Beekman RH, Lloyd T, Bove EL. Critical aortic stenosis in the neonate. A comparison of balloon valvuloplasty and transventricular dilation. J Thorac Cardiovasc Surg. 1995;109:147–154. doi: 10.1016/S0022-5223(95)70430-2 PubMed DOI

Justo RN, McCrindle BW, 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;77:1332–1338. doi: 10.1016/S0002-9149(96)00201-9 PubMed DOI

McCrindle BW, Blackstone EH, Williams WG, Sittiwangkul R, Spray TL, Azakie A, Jonas RA. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation. 2001;104:152–158. doi: 10.1161/hc37t1.094837 PubMed DOI

Reich O, Tax P, Marek J, Rázek V, Gilík J, Tomek V, Chaloupecký V, Bartáková H, Škovránek J. Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome. Heart. 2004;90:70–76. doi: 10.1136/heart.90.1.70 PubMed DOI PMC

Zoghbi WA, Adams D, Bonow RO, Enriquez‐Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303–371. doi: 10.1016/j.echo.2017.01.007 PubMed DOI

First T, Škovránek J, Marek J. Normal values of 2‐dimensional echocardiographic parameters in children. Cesk Pediatr. 1992;47:260–264. PubMed

Hraska V, Photiadis J, Arenz C. Open valvotomy for aortic valve stenosis in newborns and infants. Multimed Man Cardio‐Thoracic Surg. 2007;2007:1–6. doi: 10.1510/mmcts.2006.002311 PubMed DOI

Petit CJ, Gao K, Goldstein BH, Lang SM, Gillespie SE, Kim S‐IH, Sachdeva R. Relation of aortic valve morphologic characteristics to aortic valve insufficiency and residual stenosis in children with congenital aortic stenosis undergoing balloon valvuloplasty. Am J Cardiol. 2016;117:972–979. doi: 10.1016/j.amjcard.2015.12.034 PubMed DOI

Papneja K, Blatman ZM, Kawpeng ID, Wheatley J, Oscé H, Li B, Lafreniere‐Roula M, Fan CPS, Manlhiot C, Benson LN, et al. Trajectory of left ventricular remodeling in children with valvar aortic stenosis following balloon aortic valvuloplasty. Circ Cardiovasc Imaging. 2022;15:e013200. doi: 10.1161/CIRCIMAGING.121.013200 PubMed DOI PMC

Hill GD, Ginde S, Rios R, Frommelt PC, Hill KD. Surgical valvotomy versus balloon valvuloplasty for congenital aortic valve stenosis: a systematic review and meta‐analysis. J Am Heart Assoc. 2016;5:e003931. PubMed PMC

Gao K, Sachdeva R, Goldstein BH, Lang S, Petit CJ. Aortic valve morphology correlates with left ventricular systolic function and outcome in children with congenital aortic stenosis prior to balloon aortic valvuloplasty. J Invasive Cardiol. 2016;28:381–388. PubMed

Mahle WT, Weinberg PM, Rychik J. Can echocardiography predict the presence or absence of endocardial fibroelastosis in infants <1 year of age with left ventricular outflow obstruction? Am J Cardiol. 1998;82:122–124. doi: 10.1016/S0002-9149(98)00243-4 PubMed DOI

Lofland GK, McCrindle BW, Williams WG, Blackstone EH, Tchervenkov CI, Sittiwangkul R, Jonas RA. Critical aortic stenosis in the neonate: a multi‐institutional study of management, outcomes, and risk factors. J Thorac Cardiovasc Surg. 2001;121:10–27. doi: 10.1067/mtc.2001.111207 PubMed DOI