Valvuloplastia aórtica pediátrica: estudio de variables con influencia en los resultados a largo plazo

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Introduction and objectiveBalloon aortic valvuloplasty is regarded as a good palliative option for congenital aortic stenosis in children. Our main objective was to review the results of all consecutives balloon aortic valvuloplasties performed in children over a native valve from march 1994 until June 2013, trying to identify those variables associated with need of reintervention during follow-up. MethodsWe studied the echocardiographic, clinical and evolutionary features of 51 pediatric patients who underwent a balloon aortic valvuloplasty. Two groups were recognized: neonatal (n=11) and pediatric (n=40) patients depending on whether valvuloplasty was performed before or after the first month of life. Median follow-up was 5.8 years (0.5-12,3). ResultsThere were 37 boys and 14 girls, and 20 patients had some additional cardiac malformation. The average peak to peak hemodynamic gradient fell from 60±18 a 25±13mmHg. During follow-up, 12 patients needed a second valvuloplasty for reestenosis (23.5%) at 0.61 years (0.3-3.2) and 13 others needed surgery (25%) at 1.62 years (0.4-10.9); 2 cases (4%) had no follow-up. The variables neonatal group, echocardiographic restrictive diastolic pattern, z-score of end-diastolic left ventricle diameter<-2.5, and peak to peak hemodynamic gradient>60mmHg were associated with need of surgery during follow-up (p<0.05). However, we did not find factors associated with repeated valvuloplasty. ConclusionsBalloon aortic valvuloplasty in children is an effective option for palliative treatment of congenital aortic stenosis. In this study the variables previously described were predictors of the need of surgery.