Abstract
Balloon aortic valvuloplasty (BAV) provides an excellent alternative to surgical intervention and has become the preferred intervention for initial palliation for aortic stenosis in neonates, infants, children, adolescents, and young adults. The elderly patients with calcific aortic stenosis do not benefit from BAV. With the exception of neonates, most patients can be discharged home within 24-hours of the procedure. Although there is definitive evidence for pressure gradient relief immediately after as well as at follow-up and postponement of surgical intervention following BAV, the progression of aortic insufficiency at late follow up remain a major concern. In the neonatal population, severe aortic insufficiency may develop requiring surgical intervention. Despite these limitations, balloon aortic valvuloplasty is currently considered as therapeutic procedure of choice in the management of congenital aortic stenosis in the pediatric and young adult population. Careful follow-up to detect recurrence of stenosis and development of significant aortic insufficiency is recommended.
Highlights
Aortic stenosis (AS) is generally an isolated lesion it may be seen in association with other defects such as coarctation of the aorta and Shone's syndrome
Acute results following balloon aortic valvuloplasty reported during the decade (1983 to 1992) following its description were tabulated elsewhere [1] and the interested reader is referred to this book chapter
Anatomic, physiologic, and technical data (Table II of reference 17) were examined by multivariate logistic regression analysis to identify factors producing aortic insufficiency (AI) [17]. This analysis identified several factors that were statistically different between groups (Table IV of reference 17); these are Doppler quantitated AI both prior to and immediately following Balloon aortic valvuloplasty (BAV) and the procedure performed during the latter half of our experience with BAV
Summary
Aortic stenosis (AS) is generally an isolated lesion it may be seen in association with other defects such as coarctation of the aorta and Shone's syndrome. Post intervention pressure pullback tracings across the aortic valve (Figure 9), cardiac output measurements and left ventricular and/or aortic root angiography are performed fifteen minutes following the valvuloplasty [1,19]. The multipurpose catheter is removed and a 6–8 mm diameter Tyshak II (Braun) or ultrathin (Meditech) balloon dilatation catheter (The diameter of the balloon selected should be 0.8 to 1.0 times the aortic valve annulus.) is advanced over the guidewire from the umbilical vein, inferior vena cava, right atrium, left atrium, LV and aorta, while maintaining a wide loop of the guidewire in the left ventricle. Given the availability of better-tracking balloon valvuloplasty catheters (Figure 12) such as Tyshak II (Braun), the above described maneuvers may not be necessary in most cases [19] In this method, initially described in 1993 [32,33], a #5-F sheath is used to achieve femoral venous access. The remaining procedure is performed in a manner similar to the above described umbilical venous access method; it should be mentioned that the transumbilical venous balloon aortic valvuloplasty [34,35] is patterned after the anterograde femoral venous method [32,33]
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