Balloon valvuloplasty of aortic valve stenosis in childhood: early and medium term results
Knirsch, Walter ; Berger, Felix ; Harpes, Paul ; Kretschmar, Oliver
In: Clinical Research in Cardiology, 2008, vol. 97, no. 9, p. 587-593
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- Background: Isolated aortic valve stenosis in childhood is treated by balloon valvuloplasty. The role of independent risk factors for the outcome remains unclear. Material and methods: We analysed the early and medium term outcome of balloon valvuloplasty in isolated aortic valve stenosis in 44 pediatric patients with isolated, severe aortic valve stenosis at an age younger than 18 years, who received a primary balloon valvuloplasty during the last 5 years in our institution. We evaluated the type of aortic valve morphology, age, clinical status, and myocardial function at the time of the intervention as independent risk factor. Results: A significant early relief of the pressure gradient across the aortic valve (P < 0.001) after balloon valvuloplasty was found. This was independent of the aortic valve morphology. Two neonates with a highly stenotic tricuspid aortic valve and severely compromised haemodynamics died within the first 30 days after the intervention. During medium term follow up (mean 22.5 months) we observed a functional deterioration for the stenosis as well as for the insufficiency of the aortic valve. "Symptoms before intervention” is an independent risk factors (P < 0.001) for valvuloplasty failure. Patients at an "age at intervention ≤ 28 days” (P = 0.02) and patients with "reduced myocardial systolic function” (P = 0.01) had a shorter time to reintervention. Conclusions: The type of aortic valve morphology only has a weak predictive value for the outcome of balloon valvuloplasty during medium term follow up. Critical ill neonates with an impaired myocardial function are at a higher risk for valvuloplasty failure