Different interventions in treatment of children with congenital aortic stenosis

Abstract

Objective To evaluate the efficacy and safety of percutaneous balloon aortic valvuloplasty(PBAV) in retrograde, antegrade way or right ventricular pacing in children. Methods This was retrospective clinical study included 32 children who were treated with PBAV for congenital aortic stenosis from January 2008 to June 2017 in Guangdong Cardiovascular Institute.The general clinical data including residual stenosis and aortic stenosis again, and degree of artery injury, aortic regurgitation were particularly assessed. Results A total of 32 patients consisting of 27 boys and 5 girls underwent the procedure, with age of (55.8±52.0) months (ranging from 20 days to 15 years) and body weight (18.2±14.0) kg (ranging from 3.5 kg to 59.0 kg). Two infants accepted left cardiac catheterization through femoral vein and one with interventional indication then accepted PBAV through the patent foramen ovale.The others underwent the retrograde way, including 24 cases with rapid right ventricular pacing.The catheter-measured peak systolic the aortic valve gradient decreased from (81.6±28.0) mmHg(1 mmHg=0.133 kPa) to (41.4±19.0) mmHg immediately after percutaneous interventional treatment, and the difference was statistically significant(t=9.543, P=0.000). The peak systolic valve gradient mea-sured pre-PBAV and on the second day after PBAV measured by Doppler echocardiography decreased from (82.7±23.0) mmHg to (44.6±18.0) mmHg, and the difference was statistically significant(t=11.732, P=0.000). The diameters of the aortic valve were (13.8±3.0) mm(ranging from 6.5 mm to 21.0 mm) and the balloons were (14.1±4.0) mm(ranging from 6 mm to 23 mm). The follow-up period was 1 to 72 months.The peak systolic valve gradient measured by Doppler echocardiography increased from (44.6±18.0) mmHg to (58.6±30.0) mmHg, and the difference was statistically significant(t=-2.549, P=0.016). During the procedure, 5 children(14.7%) accepted surgery for restenosis or regurgitation.Seven had regurgitation, one had femoral artery embolism and one died on the second day after the procedure. Conclusions With the diversification of procedures and the continuous improvement of interventional devices, PBAV can play a very good role in alleviating congenital aortic stenosis in children, and the safety has been continuously improved. Key words: Aortic stenosis; Intervention; Child