Objectives To evaluate our experience with anterograde balloon dilation in patients with critical aortic stenosis.
Methods Retrospective review of the angiograms, the hemodynamic measurements and echocardiolograms of 17 neonates patients with critical aortic stenosis. The mean age was 12 days, mean body weight was 3.3 kg. One patient had hypoplasia of the left ventricle (HLH), one patient was diagnosed with endocardial fibroelastosis (EFE). Prostaglandin E1 was administered in 7/17 patients. All patients had severe left ventricular dysfunction and critical aortic stenosis as documented by echocardiography. Inotropic support was necessary in 4/17 patients.
Results In all 17/17 patients dilatation of the critical aortic stenosis was possible using an anterograde transvenous approach. In 16 patients a persistent foramen ovale was used for passage to the left atrium, transseptal puncture was performed in one patient. Angioplasty catheters of 3 mm to 8 mm diameters were used, in one patient a double-coronary angioplasty balloon technique was used. Periprocedural mortality was 0%. Periinterventionally 2 patients became asystolic but sinus rhythm was quickly restored with single boluses of adrenalin and atropin. No perforation of the aortic valve occured. Mitral regurgitation did not increase after anterograde balloon dilatation of the aortic valve. The pre-interventional mean systolic gradient was 73 mmHg. Balloon dilatation reduced the gradient to 37 mmHg. In 15 patients aortic regurgitation (AR) after balloon valvoloplasty was < °II, one patient had °II AR and one patient °III AR. Left ventricular function improved significantly in all patients after the dilatation. During the follow-up one patient with HLH died during a Daymus-Kaye-Stansel operation at 6 weeks, the patient with EFE died at 8 months of age.
Conclusions Balloon dilation of critical aortic stenosis can be effectively and safely performed using an anterograde approach.