Cardiology Letters 2014, 23(4):259-266

Long-term follow-up of aortic stenosis after balloon valvuloplasty in childhood - single center results

Goldschmidtová E, Kaldarárová M, Nosáľ M, Mašura M

NÚSCH a.s. - Detské kardiocentrum v Bratislave, Slovenská republika

Aortic stenosis (AS) represents 3-7.8% of all congenital heart defects and most frequently is located on the valvar level. In severe gradient (>80 mm Hg) symptoms, or in the newborn in the event of left ventricular failure, intervention is indicated. Balloon valvuloplasty and surgical valvuloplasty are palliative procedures; further possibilities are valvar replacements - either with pulmonary autograft (Ross procedure), homograft or mechanical valve replacement. Aim of the study was a retrospective analysis of long-term results with balloon valvuloplasty, analysis of residual findings and the need of further interventions. Patients: Analyzed were 60 patients (66.6% males and 33.3% females), who underwent balloon valvuloplasty at our institution between 1987-2007, with long-term follow-up 12.3 years (median).

Results: Good or partial immediate effect was achieved in 95% of patients, with statistically significant decrease of AS gradient [median 80→36.5 mmHg (p<0,0001)], with nonsignificant increase during follow-up. After procedure though the number of patients with significant aortic regurgitation (AR) substantially increased - to 30% early and to 55% of patients in long-term follow-up. Reinterventions were needed in 31 (51.6%) patients, who underwent 40 reinterventions, out of which 39 were on aortic valve (in 4 patients revalvuloplasty, in 13 Ross procedure, in 16 surgical valvuloplasty, in 5 mechanical valve implantation and in 1 patient aortic valve replacement with homograft). Reinterventions were performed 9.5 years (median) after balloon valvuloplasty, dominantly due to newly developed severe AR (in 43.6%), due to combined aortic affection (in 35.9%), or due to repeated progression of AS (in 20.5% patients).

Conclusions: The only management possibility for severe valvar AS is intervention. Due to specificity of pediatric age there is no consensus regarding the most optimal type of solution. The disadvantage of most interventions is their "temporality", with the need of repeated procedures, not only due to progression of previous AS but also due to new pathologies that have to be taken into account and have to be treated.

Keywords: ; aortic stenosis; balloon valvuloplasty; surgical valvuloplasty; Ross procedure; mechanic aortic valve replacement; long-term follow-up

Published: April 1, 2014  Show citation