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PERCUTANEOUS BALLOON AORTIC VALVULOPLASTY IN CHILDHOOD
IVAN MALČIĆ
orcid.org/0000-0002-1060-0988
; Klinički bolnički centar Zagreb, Odjel za pedijatrijsku kardiologiju, Zagreb, Hrvatska
FRANK UHLEMANN
; Centar za prirođene srčane bolesti, Olgahospital, Stuttgart, Njemačka
Sažetak
We assessed the effectiveness of aortic balloon valvuloplasty (AoVP) in 34 children who were admitted for aortic valve balloon dilatation over 7 years (Feb 1997-Feb 2004) in two institutions (Stuttgart and Zagreb). There was a prevalence of male children (28/6; p<0.01), mean age at dilatation 35.55±55.59 months (mean ± SD, min 1 day, max 14.2 years) and mean body weight 13.1±15.9 kg (min 2640 g, max 57 kg). Patients were divided into two groups as follows: group 1 including neonates and small infants younger
than 2 months at dilatation with criteria for critical aortic stenosis (n=18); and group 2 including infants older than 2 months at
dilatation (n=16). Sixteen (47%) of all patients had no clinical symptoms, 12 (35.3%) were dyspneic at rest and sweating at feeding (NYHA III), and 6 (17.6%) had severe heart failure (NYHA IV). All NYHA IV patients were in group 1 (n=6) versus 0 in group 2
(p<0.05). According to ECHO estimation, left ventricular (LV) function was normal in 16 (47%), moderately limited in 12 (35.3%)
and severely impaired in 6 (17.6%) patients. All patients with severely impaired LV function belonged to group 1 (n=6) versus 0
in group 2 (p<0.05). Balloon dilatation was performed retrogradely via the percutaneous femoral artery approach in all except
one patient in which the balloon catheter was introduced anterogradely via the mitral valve (MV). Indexed aortic valve-annulus/body surface area (BSA) (mm/m2) was 30.97±10.02) (max 47.5, min 12.02) for overall study sample, 37.60±5.99 in group 1 and 23.03±7.86 in group 2 (group 1 vs. group 2, p<0.05). Ao/Ba ratio (mm) was 0.85±0.09 for overall study sample, 0.81±0.11 for group 1 and 0.89±0.05 for group (group 2 vs. group 1, p<0.01). Immediately after dilatation, the mean systolic pressure gradient across the aortic valve decreased from 70.62±20.78 (max 120, min 45 mm Hg) to 20.03±13.7 (max 65, min 0 mm Hg) in the whole study group (p<0.05), from 73.23±21.57 (max 120, min. 50 mm Hg) to 15.25±11.09 (max 40, min 0 mm Hg) in group 1 (p<0.05), and from 67.78±20.21 (max 111, min 45 mm Hg) to 24.81±14.71 (max 65, min 10 mm Hg) in group 2 (p<0.05) (catheter measurement). Follow-up results were studied in 31 (91%) patients at 3.5-84 months (20.91±22.19) after AoVP and revealed continuously increasing residual aortic valve gradient (31.35±12.01, max 50, min 15 mm Hg), still being significantly lower (p<0.001) than before valvuloplasty. The overall actuarial survival rate after 7 years was 91%. Freedom of three categories (any reintervention, surgical reintervention, and re-dilatation) was 77, 74, 61; 87, 84, 77; and 90, 90, 83 at 2, 4 and 7 years for the total number of patients, respectively. The actuarial freedom for the same categories in group 1 vs. group 2 was 72, 67, 56 vs. 87, 87, 75 (p<0.05); 89, 83, 78 vs. 87, 87, 75 (NS); 83, 83, 78 vs. 100, 100, 94 (p<0.05) at 2, 4 and 7 years. The degree of aortic regurgitation immediately after catheterization did not significantly increase; only 1 patient developed moderate aortic regurgitation, which was treated with surgical valve reconstruction on day 1 after intervention. At follow-up, aortic regurgitation increased to grade 3 in 3 (10%) and to grade 2 in 7 (23.3%) patients. All three patients with high grade of aortic insufficiency were from group 1 vs. 0 in group 2 (p<0.05). Eight (26%) patients required reintervention, 4 (13%) balloon valvuloplasty plus surgery, and 4 surgery only. Of 8 patients requiring surgery, 4 (13%) were operated on during a period of 27-78 months and 4 within one month after dilatation. One patient died one week after dilatation, re-dilatation and surgery due to fibroelastosis (confirmation by histology). Conclusion: Percutaneous balloon valvotomy provides an effective palliative interventional method in the treatment of infants and children with aortic valve stenosis. The majority of problems in the early and late period after dilatation appear in the group of patients with critical aortic stenosis.
Ključne riječi
aortic stenosis; interventional catheterization; balloon aortic valvuloplasty; neonates; infants; children; outcome; immediate and mid-term follow-up
Hrčak ID:
310004
URI
Datum izdavanja:
22.11.2023.
Posjeta: 233 *