Balloon Aortic Valvoplasty Research Articles

Surgical versus balloon valvotomy in neonates and infants: results from the UK National Audit

ObjectiveThere are conflicting data on choosing balloon aortic valvoplasty (BAV) or surgical aortic valvotomy (SAV) in neonates and infants requiring intervention for aortic valve stenosis. We aim to report the...

Balloon Aortic Valvoplasty in Patient With Severe Calcific Aortic Stenosis and Cardiogenic Shock

The standard treatment of calcific aortic stenosis (AS) is aortic valve replacement (AVR). However, as population has become older, the number of patients who have prohibitive surgical risk is increasing. Although transcatheter aortic valve implantation (TAVI) has been indicated to some of these high-risk patients, its indication is limited because of anatomical contraindications, unstable clinical situations and financial problems. Thus, in experienced hands, the option for balloon aortic valvoplasty (BAV) should be considered, as it may be a good alternative to selected patients to ameliorate symptoms and prolong survival. In this report, we describe the case of an old patient with severe AS who evolved with cardiogenic shock and had contraindications to surgery and transcatheter valve implantation and who was successfully treated by BAV. J Med Cases. 2014;5(11):583-586 doi: http://dx.doi.org/10.14740/jmc1953e

Ascending aortitis and aortic valve endocarditis in an infant

FIGURE 1. Gross image of the aorta showing irregular mural vegetation adjacent to an area of mural necrosis and early aneurysm formation. (Original magnification, 1.53.) CLINICAL SUMMARY A 5-month-old boy presented with fever, tachycardia, and a systolic heart murmur. At 1 month of age, he had been treated for congenital aortic stenosis (AS) with balloon aortic valvoplasty. Six weeks before the present illness, a catheterization was performed to assess the residual left ventricular outflow tract gradient and pulmonary vascular bed. During the procedure, there was no suspicion of an intimal tear or dissection. This study and a subsequent echocardiogram showed mild AS and trace aortic insufficiency. After a lumbar puncture, antibiotics were initiated for a presumptive diagnosis of meningitis. Two days later, there was seizure activity, and imaging showed a subacute infarction in the right middle cerebral artery distribution. Blood culture results were positive for Enterococcus faecalis. An echocardiogram revealed thickened aortic valve leaflets with vegetation adjacent to the left cusp and an abnormal appearance of the ascending aorta, suggesting aortitis with intraluminal hematoma, dissection, or pseudoaneurysm. Brain magnetic resonance imaging demonstrated an evolving infarction in right middle cerebral artery distribution. The patient was seizure free and had no focal neurologic findings. Surgical intervention was planned to replace the aortic valve and ascending aorta. At the time of the operation, the entire ascending aorta appeared thickened and inflamed (Figures 1 and 2). Aortic cannulation was performed more distal than usual in the transverse arch to allow for high aortic crossclamp place-

Experience in a single centre with percutaneous aortic valvoplasty in children, including those with associated cardiovascular lesions

We report the experience in a single institution with balloon aortic valvoplasty for congenital aortic stenosis. Unlike most other reported series, we included patients with associated lesions involving the left side of the heart. Between November, 1986, and November, 2006, we performed 161 interventions on 143 patients, of whom 33 were neonates, 33 infants, and 77 children, just over one-quarter (28.6%) having associated lesions. The overall reduction in peak-to-peak gradient of 60 ± 24% (p < 0.01), was more effective in primary versus secondary intervention (63 ± 24% versus 47 ± 23%; p < 0.03), and in those with fused bifoliate as opposed to truly bifoliate valves (66 ± 17% versus 53 ± 30%; p = 0.01). Patients with associated lesions were younger (40.89 ± 60.92 months versus 81.9 ± 72.9 months; p = 0.001), and were less likely to achieve a final pressure gradient of less than 20 mmHg (35.0% versus 61.2%; p < 0.01). Overall mortality was higher in cases with associated lesions (27.5% versus 1.9%; p < 0.0001) but not catheter-related death (2.5% versus 1.9%; p = 1.0). Reintervention was more frequently required in infants (p = 0.02) but not in cases with associated lesions (p = 0.35). Balloon valvoplasty is a safe and effective method for the treatment of congenital aortic stenosis. Prior surgery to the aortic valve, reintervention, associated cardiovascular lesions, and the anatomy of the valve predict a less effective reduction in the gradient. Major complications and catheterization-related death are mainly secondary to very young age, but not to associated cardiac lesions.

Axillary artery approach for balloon valvoplasty in young infants with severe aortic valve stenosis: Medium‐term results

To assess the feasibility and results of trans-axillary approach for balloon aortic valvoplasty (BAV) in early infancy. Severe aortic valve stenosis (SAVS) is rare but serious condition in infancy, which may be promptly treated either by surgical aortic valvotomy or BAV. BAV is usually performed via the femoral artery route, which is associated with significant vascular complications and long procedure times. BAV via the trans-axillary approach was performed on twenty-seven sequential infants with SAVS presenting to a single tertiary referral center over an 11-year period. Maximum inflated balloon size was less than or equal to the aortic valve diameter. Twenty-seven infants aged 1-77 days underwent BAV. Weight at time of procedure was 2.0-4.42 kgs. The median procedure and screening times were 82 and 7.9 minutes, respectively. Mean instantaneous Doppler gradient across the aortic valve reduced from 68 +/- 33 to 37 +/- 14 mmHg ( p < 0.0001). Three infants developed at least moderate aortic regurgitation. Right arm pulse volume was decreased in 12 infants; 5 received an intravenous heparin infusion. Longer-term follow-up demonstrated reduced or absent peripheral pulse in 5 infants. Transection of the axillary artery occurred in one infant requiring emergency microvascular repair. There was one post-procedural and one late death due to non-cardiac causes. In early infancy balloon aortic valvoplasty via the axillary artery approach for severe aortic stenosis is an acceptable and safe alternative to the femoral arterial approach and results in short procedure and screening times. Longer-term vascular follow-up is required. (c) 2006 Wiley-Liss, Inc.

Successful neonatal balloon aortic valvoplasty following prenatal diagnosis of critical aortic stenosis

SummaryWe report a successful neonatal balloon aortic valvoplasty after prenatal diagnosis of critical aortic stenosis with severe left ventricular dysfunction. The infant was delivered by cesarean section at 34 weeks of gestation and had balloon valvoplasty via the right common carotid artery 67 minutes after birth. Left ventricular contraction improved immediately after the procedure. Scheduled balloon aortic valvoplasty immediately after birth subsequent to prenatal diagnosis can improve the outcome of critical aortic stenosis.

Survival after fetal aortic balloon valvoplasty

The pre- and postnatal course of a child surviving after successful intrauterine balloon aortic valvoplasty for critical aortic stenosis is described. She is now well at 4 years of age. A clearer understanding of the hemodynamics in such cases and improved catheter technology are necessary before this is advocated as a generally applicable technique. However, the outcome in this case is promising for the future of fetal interventional procedures.

Aortic valvoplasty: Comparison of the techniques and results of transeptal and retrograde methods

Balloon aortic valvoplasty is used in some patients with aortic valve stenosis who are unsuitable for aortic valve replacement. Complications associated with the retrograde approach can be avoided using an antegrade approach which has been less widely described. Experience of these two methods is reported and aspects of the differences in technique are emphasized. Aortic valvoplasty was attempted in 21 patients with severe aortic valve stenosis (mean gradient 65 mmHg). A significant reduction in gradient was achieved in 20 (mean reduction 59% transeptal group [four patients], 50% retrograde group [16 patients]) with symptomatic improvement in 18 patients which was maintained at follow-up (mean interval of 5.2 months, range 1-17 months) in 8/15 patients. There were only two significant, resolvable early complications and increases in aortic regurgitation were not seen. There were six late deaths but three patients improved sufficiently to undergo successful aortic valve replacement. Aortic valvoplasty provides good palliation of symptoms. In patients who are unsuitable for the retrograde approach the antegrade, transeptal approach is a satisfactory and effective alternative.