Intermediate-term follow-up results of balloon aortic valvuloplasty in infants and children with special reference to causes of restenosis

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Abstract

Sixteen infants and children with valvular aortic stenosis underwent percutaneous balloon aortic valvuloplasty over a 36-month period ending August 1988. The mean systolic pressure gradient across the aortic valve decreased from 72 ± 21 (mean ± standard deviation) to 28 ± 13 mm Hg (p < 0.001) immediately after valvuloplasty; the degree of aortic insufficiency did not significantly increase. Follow-up catheterization (in 10 patients) and Doppler data (in all 16 patients) were available 3 to 32 months (mean 12 months) after valvuloplasty and revealed a residual aortic valvular gradient of 37 ± 23 mm Hg, which continues to be significantly lower (p < 0.001) than that before valvuloplasty. There was no increase in aortic insufficiency. On the basis of follow-up data, the 16 children were divided into 2 groups: group I with good results (gradients ≤ 49 mm Hg), 12 patients; and group II with poor results (gradients ≥ 50 mm Hg), 4 patients. All 4 patients in group II required repeat balloon valvuloplasty or surgical vatvotomy; none from group I required these procedures. Seventeen general, anatomic, physiologic and technical variables were examined by a multivariate logistic regression analysis to identify factors associated with restenosis; these,risk factors were: age ≤ 3 years; and immediate aortic valvular gradient after valvuloplasty ≥ 30 mm Hg. The immediate and intermediate-term follow-up results of balloon aortic valvuloplasty are encouraging. Recognition of the risk factors may help identify potential candidates for recurrence. Attempts to reduce the immediate gradients after balloon valvuloplasty to < 30 mm Hg may prevent recurrences at intermediate-term follow-up.

References (31)

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This study was supported in part by a grant from the Oscar Rennebohm Foundation, Madison, Wisconsin.

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