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Experience in a single centre with percutaneous aortic valvoplasty in children, including those with associated cardiovascular lesions

Published online by Cambridge University Press:  01 August 2009

David Crespo ,
Joaquim Miró ,
Suzanne J Vobecky ,
Nancy Poirier ,
Chantal Lapierre ,
Naicheng NZ Zhao  and
Nagib Dahdah
David Crespo
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics Cardiología Infantil, Departamento de Pediatría, Fundación Hospital de Alcorcón, Madrid, Spain
Joaquim Miró
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics
Suzanne J Vobecky
Affiliation:
Pediatric Cardiac Surgery, Department of Surgery
Nancy Poirier
Affiliation:
Pediatric Cardiac Surgery, Department of Surgery
Chantal Lapierre
Affiliation:
Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
Naicheng NZ Zhao
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics and Division of Pediatric Cardiology, Department of Pediatrics, Nanjing Children’s Hospital, Nanjing, China
Nagib Dahdah*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics
*
Correspondence to: Nagib Dahdah, MD, Division of Pediatric Cardiology, CHU Sainte-Justine, 3175, Côte Sainte-Catherine, Montréal, Quebec, H3T 1C5, Canada. Tel: 514-345-4931 (5403); Fax: 514-345-4896; E-mail: ndahdah@pol.net
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Abstract

Background

We report the experience in a single institution with balloon aortic valvoplasty for congenital aortic stenosis. Unlike most other reported series, we included patients with associated lesions involving the left side of the heart.

Methods

Between November, 1986, and November, 2006, we performed 161 interventions on 143 patients, of whom 33 were neonates, 33 infants, and 77 children, just over one-quarter (28.6%) having associated lesions.

Results

The overall reduction in peak-to-peak gradient of 60 ± 24% (p < 0.01), was more effective in primary versus secondary intervention (63 ± 24% versus 47 ± 23%; p < 0.03), and in those with fused bifoliate as opposed to truly bifoliate valves (66 ± 17% versus 53 ± 30%; p = 0.01). Patients with associated lesions were younger (40.89 ± 60.92 months versus 81.9 ± 72.9 months; p = 0.001), and were less likely to achieve a final pressure gradient of less than 20 mmHg (35.0% versus 61.2%; p < 0.01). Overall mortality was higher in cases with associated lesions (27.5% versus 1.9%; p < 0.0001) but not catheter-related death (2.5% versus 1.9%; p = 1.0). Reintervention was more frequently required in infants (p = 0.02) but not in cases with associated lesions (p = 0.35).

Conclusions

Balloon valvoplasty is a safe and effective method for the treatment of congenital aortic stenosis. Prior surgery to the aortic valve, reintervention, associated cardiovascular lesions, and the anatomy of the valve predict a less effective reduction in the gradient. Major complications and catheterization-related death are mainly secondary to very young age, but not to associated cardiac lesions.

Keywords

Aortic stenosislongitudinalconsecutive series
Type
Original Articles
Information
Cardiology in the Young , Volume 19 , Issue 4 , August 2009 , pp. 372 - 382
Copyright
Copyright © Cambridge University Press 2009

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