Percutaneous single- and double-balloon aortic valvotomy in adolescents and young adults with congenital aortic stenosis.

Abstract

Percutaneous balloon aortic valvotomy was attempted in six consecutive adolescents and young adults, (mean age 18 +/- 5 years), with severe congenital aortic valvular stenosis. Peak systolic aortic valve gradient measurement and aortography was performed before and immediately after valvotomy, and a 1-6 months follow-up. The single-balloon technique was used in two patients and the double-balloon technique in four patients. After balloon valvotomy the mean peak systolic aortic valve gradient (PSG) decreased from 122 +/- 53 to 43 +/- 20 mmHg (P less than 0.01). The haemodynamic improvement persisted at follow-up (PSG = 47 +/- 31 mmHg), except in one patient who had previously undergone aortic surgical valvotomy. One balloon valvotomy was unsuccessful, presumably because of the selection of an inappropriately small balloon. Two patients with critical aortic stenosis (PSG greater than 165 mmHg), who exhibited a thick aortic valve on echocardiography with a relatively small aortic root and annulus, had a dramatic reduction in PSG. However, the degree of aortic regurgitation increased significantly in both cases. The theoretical haemodynamic advantage of the double versus the single balloon techniques was confirmed in one patient. We have demonstrated that percutaneous balloon aortic valvotomy using either the single- or double-balloon technique is feasible in young adults with severe congenital aortic stenosis. Further studies are required both to define appropriate patients and the selection of balloon diameter and length.