Percutaneous Balloon Aortic Valvuloplasty Research Articles

Long-Term Results of Percutaneous Balloon Aortic Valvuloplasty in Children With Aortic Stenosis: A Single-Center Experience

Long-Term Results of Percutaneous Balloon Aortic Valvuloplasty in Children With Aortic Stenosis: A Single-Center Experience

Kiosk 1Q-FA-01 - Percutaneous Balloon Aortic Valvuloplasty During Pregnancy - A Case Report

Kiosk 1Q-FA-01 - Percutaneous Balloon Aortic Valvuloplasty During Pregnancy - A Case Report

Rescue aortic valvuloplasty for severe aortic stenosis is simple and effective in severely hemodynamically compromised patients presenting to centers without on-site heart surgery or TAVI facilities.

Management of high-risk patients with severe aortic stenosis (AS) is a challenging issue. The prognosis of patients with AS presentingwiththerapy-refractory pulmonaryedema (RPE)or cardiogenic shock (CS) remains poor. The purpose of this study was to assess the 30-day mortalityof rescue percutaneous balloon aortic valvuloplasty (PBAV)in AS patients presentingwithRPEor CSina community-based hospital without on-site heart surgery. From January 2016 to February 2019,we identified consecutively admittedpatients with CS or RPE related tosevere ASwho underwent emergent PBAV. The primary end point was 30-day mortality. Secondary end points included procedural adverse events according to the Valve Academic Research Consortium (VARC)-2 criteria and predictive factors of the primary end point. We identified 51 patients with either CS (n = 22) or RPE (n = 29). All PBAV procedures were successful with a significant reduction in peak-to-peak gradient (median, [IQR] from 40 [27] mmHg to 15 [20] mmHg, p < 0.001). No procedural deaths occurred, while adverse events included stroke (4%), minor vascular complications (6%), minor (4%) and major bleedings (4%), and no life-threatening bleeding. Overall, 15 deaths (29%) were noted at 30days after PBAV, while 53% of the surviving patientswere successfully bridged to transcatheter aortic valve implantation (TAVI). 30-day mortality was significantly higher in the CS group compared to the RPE (n = 10 (45%) vs n = 5 (7%), p = 0.029), and was significantly associated with the presence of acute kidney injury (OR 9.09, 95% CI 2.13-38.77, p = 0.003) and elevated pulmonary artery systolic pressure (OR 1.06, 95% CI 1.0-1.12, p = 0.047). Rescue PBAV in patients with severe AS presenting withRPEor CSis a feasible and effective therapeutic option,even in a community-based hospital without on-site heart surgery. Rescue PBAVresultedin 30-day survival of more than 70%, with more than half of the surviving patientshaving been successfully bridged to TAVI.

Fetal aortic valvuloplasty in a patient with critical, congenital aortic valve stenosis and severe left ventricular dysfunction

We present a case of prenatal diagnosis of critical congenital aortic valve stenosis with progressive systolic left ventricular failure. An ultrasound-guided balloon aortic valvuloplasty was performed at 28 weeks of gestational age because of left ventricular dysfunction associated with signs of fetal heart failure. There were no significant post-procedural complications and the pregnancy was carried to term with elective cesarean section at 38 weeks of gestational age. At birth, an echocardiogram showed severe aortic valve stenosis with global hypokinesia of the left ventricle. Therefore a percutaneous balloon aortic valvuloplasty was repeated through transseptal approach with prompt improvement of the antegrade aortic flow and of the left ventricular systolic function. The baby is currently 2 months old and he is doing fine.

Percutaneous balloon aortic valvuloplasty: palliative treatment for inoperable patients?

Purpose: The number of elderly patients with severe aortic stenosis and comorbidities is increasing in the aging populations of “developed” countries. Unacceptably high perioperative mortality and morbidity makes the decision to undertake surgical aortic valve replacement in this group of patients difficult and unlikely. Development of less invasive procedures such as balloon aortic valvuloplasty and transcatheter aortic valve replacement is emerging as another treatment option.&#x0D; Case report: A 84-year-old female with previous left-sided hemiparesis after stroke and severe aortic stenosis presented with pulmonary edema to our institution. Non-invasive ventilation and inotropic support were unsuccessful. Balloon aortic valvuloplasty was done as as emergency procedure and she improved immediately. She was discharged after 25 days of inhospital treatment. She died 8 weeks later of unrelated reasons (infected decubitus and sepsis).&#x0D; Conclusion: Balloon aortic valvoluplasty might be used as temporary and interim therapeutical options for patients with severe aortic stenosis and acute left ventricular failure who have unacceptably high risks when aortic valve replacement or emergency transcatheter aortic valve implantation is considered. Balloon aortic valvuloplasty may be used as a bridge to both procedures.

Open-sleeve technique: A new approach for aortic valve leaflet reconstruction in small children.

A boy was diagnosed with a unicuspid aortic valve with severe stenosis at birth. Percutaneous balloon aortic valvuloplasty was performed four times; however, he had severe heart and growth failure. Thus, aortic valve repair was performed at age 2 years and 6 months. He weighed 6.6 kg. The aortic valve annulus diameter was 9.8 mm (z value = 0.43). We report on a small toddler with congenital aortic stenosis who was successfully treated with autologous pericardial aortic valve leaflet reconstruction using the open-sleeve technique.

Outcomes of Percutaneous Balloon Aortic Valvuloplasty in Patients Undergoing Transcatheter Aortic Valve Replacement

Outcomes of Percutaneous Balloon Aortic Valvuloplasty in Patients Undergoing Transcatheter Aortic Valve Replacement

Successful percutaneous balloon aortic valvuloplasty for worsening paravalvular leakage detected oneweek after the balloon expandable transcatheter aortic valve replacement.

Successful percutaneous balloon aortic valvuloplasty for worsening paravalvular leakage detected oneweek after the balloon expandable transcatheter aortic valve replacement.

Improvement in right ventricular function by mitral valve closure in hypoplastic left heart syndrome.

A male neonate presented with the aortic/mitral stenotic variant of hypoplastic left heart syndrome, wherein the suprasystemic left ventricular pressure and relatively large left ventricle had shifted the intraventricular septum. Despite bilateral pulmonary artery banding, the stroke volume was difficult to maintain owing to the compressed right ventricle, causing heart failure symptoms. Percutaneous balloon aortic valvuloplasty decreased the left ventricular pressure, restoring the right ventricular function. Norwood procedure with mitral valve closure after catheter intervention reduced the left ventricular size and improved the right ventricular function. This paper refers to the potential of mitral valve closure for hypoplastic left heart syndrome.

Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country.

Background Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone's syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era

Abstract Background In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure. Purpose To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS). Methods Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up. Results One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p&amp;lt;0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p&amp;lt;0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p&amp;lt;0.001). Conclusion In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192) Figure 1 Funding Acknowledgement Type of funding source: None

Long-term outcome of percutaneous balloon aortic valvuloplasty for children with congenital aortic valve stenosis

Objective: To assess the efficacy and long-term outcome of percutaneous balloon aortic valvuloplasty (PBAV) for children with congenital aortic stenosis (CAS) and to explore risk factors for significant aortic regurgitation (AR) and reintervention after PBAV during follow up. Methods: This was a retrospective study. Children (≤18 years old) with CAS, who underwent PBAV in Guangdong Provincial Hospital from January 2004 to December 2018, were included in this study. Demographic, preoperative transthoracic echocardiography (TTE) and surgical data were collected. Postoperative complications were closely observed, and the patients were followed up at 1, 6, 12 months after the operation, and then at one year interval thereafter. Endpoint events included significant AR and reintervention. Reintervention was defined as any intervention that needed to be performed on the valve for various reasons, including re-PBAV, surgical valvuloplasty and valve replacement. Significant AR was defined as AR grade≥3 by TTE criteria. The results of the last TTE examination before the end of the study were collected. The Kaplan-Meier curve for long-term AR-free and intervention-free survival was plotted. Cox regression model was used to further analyze the risk factors for significant AR and reintervention after PBAV in CAS patients. Results: A total of 55 patients were enrolled in this study, and the age was 4.6(1.6, 6.5) years, with 37(67.3%) males. The peak systolic valve gradient fell from (80.3±30.6)mmHg to (38.5±18.5)mmHg(P<0.001, 1 mmHg=0.133 kPa). Surgical success rate was 89% (49/55). Acute post-PBAV AR occurred in 18 patients, including 3 patients with RA≥3 grade. In-hospital complications occurred in 6 patients (2 deaths, 2 cases of transient arrhythmia, and 2 cases of femoral artery embolization). Fifty patients accomplished the follow-up and the follow-up time was 6.2(3.4, 8.5) years. Significant AR was found in 20 patients. Significant AR-free survival rate was 53% at 5 years and 19% at 10 years. Reintervention was performed in 11 patients (4 with valvuloplasty and 7 with valve replacement), and the 5-year and 10-year intervention-free survival rates were 87% and 62%, respectively. Multivariate Cox regression analysis showed that acute post-PBAV AR was a risk factor for long-term significant AR (HR=2.398, 95%CI 1.007-5.712, P=0.048). Post-PBAV residual pressure gradient ≥ 35 mmHg (HR=4.747, 95%CI 1.116-19.329, P=0.030)and acute post-PBAV AR (HR=5.104, 95%CI 1.083-24.065, P=0.039)were risk factors for re-intervention. Conclusions: PBAV is safe and effective in the treatment of CAS in children, but attention should be paid on significant AR post procedure. Acute post-PBAV AR is a risk factor for re-intervention and significant AR post PBAV, and high post-PBAV residual pressure gradient is a risk factor for re-intervention.

Contemporary use of balloon aortic valvuloplasty and evaluation of its success in different hemodynamic entities of severe aortic valve stenosis.

To evaluate outcome assessment of percutaneous balloon aortic valvuloplasty (BAV) in different flow and gradient patterns of severe aortic stenosis (AS). The mean pressure gradient reduction after BAV is an often-used surrogate parameter to evaluate procedural success. The definition of a successful BAV has not been evaluated in different subgroups of severe AS, which were introduced in the latest guidelines on the management of patients with valvular heart disease. In this observational study, consecutive patients from July 2009 to March 2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG), and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic, and clinical information were collected and compared. One-hundred-fifty-six patients were grouped into NFHG (n = 68, 43.5%), LFLG (n = 68, 43.5%), and pLFLG (n = 20, 12.8%) AS. Mean age of the study population was 81 years. Cardiogenic shock or refractory heart failure (46.8%) was the most common underlying reasons for BAV. Spearman correlation revealed that the mean pressure gradient reduction, determined by echocardiography, had a moderate correlation with the increase in the aortic valve area (AVA) in patients with NFHG AS (ρ: 0.529, p < .001) but showed no association in patients with LFLG (ρ: 0.017, p = .289) and pLFLG (ρ: 0.030, p = .889) AS. BAV as bridge to surgical or transcatheter aortic valve replacement was possible in 44.2% of patients, with no difference between groups (p = .070). The mean pressure gradient reduction might be an adequate surrogate parameter for BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities.

Long-term results of percutaneous balloon aortic valvuloplasty in children with aortic stenosis: a single-center experience.

Percutaneous balloon aortic valvuloplasty (BAV) is an effective method of treatment for aortic stenosis in children. This study aimed to assess the long‑term results of BAV in various age groups in the pediatric population. This retrospective study included 68 patients (newborns, infants, and children older than 1 year). We analyzed their demographic data and measurements performed with the use of cardiac catheterization, angiography, and echocardiography at 3 time points: before, directly after, and at late follow‑up after BAV, including the invasive aortic valve peak‑to‑peak systolic pressure gradient (PGpeak), maximum systolic pressure gradient (PGmax) by Doppler echocardiography, and the severity of aortic regurgitation (AR). Long‑‑term follow‑up data were available for 57 patients. The BAV procedure led to a significant reduction in the PGpeak values. Late follow‑up revealed a progression of AR. Aortic regurgitation of grade 2 or higher directly after BAV was the strongest risk factor for severe AR at late follow‑up. After 5, 10, and 18 years after BAV, surgical treatment was not required in 90%, 77%, and 59.5% of patients, respectively. Severe AR and a residual PG less than 35 mm Hg at late follow‑up were stronger risk factors for aortic valve surgery than moderate AR and PG higher than or equal to 35 mm Hg. Balloon aortic valvuloplasty is an effective method of treatment for aortic stenosis in children, which delays the need for surgery. The progression of AR occurs at late follow‑up. A greater reduction in PGmax is a risk factor for at least moderate AR directly after BAV, which results in the progression of AR at late follow‑up.

Ultrasound-Guided Percutaneous Balloon Aortic Valvuloplasty for Aortic Stenosis.

Percutaneous balloon aortic valvuloplasty (PBAV), which is used to treat symptomatic aortic stenosis, requires ionizing radiation and contrast agent for imaging guidance. The aim of the study is to evaluate the feasibility and effectiveness of ultrasound-guided PBAV in patients with aortic stenosis. This case series included 30 patients (14 males; mean age, 61.5 ± 4.5 years) with moderate/severe aortic stenosis treated with ultrasound-guided PBAV at the Ultrasound Department, Fuwai Hospital, Beijing, China, between January 2016 and July 2019. Cardiac function (New York Heart Association grade) was assessed before PBAV and 1 month after the procedure. Aortic peak jet velocity, aortic valve orifice area (AVA), mean transvalvular pressure gradient (MTPG), left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were determined before and immediately after PBAV using Doppler echocardiography. Preprocedural cardiac function was grade I in 3 cases, grade II in 9 cases, grade III in 10 cases, and grade IV in 8 cases. Postprocedural cardiac function was grade I in 22 cases, grade II in 4 cases, and grade III in 4 cases, suggesting that cardiac function was improved by PBAV. Ultrasound-guided PBAV resulted in significant improvements (P < 0.05) in aortic peak jet velocity (3.68 ± 0.811 m/s vs. 4.79 ± 0.63 m/s), MTPG (33.77 ± 13.85 mmHg vs. 54.54 ± 13.81 mmHg), AVA (1.96 ± 0.25 cm2 vs. 0.98 ± 0.12 cm2), LVEDD (51.90 ± 3.21 mm vs. 65.60 ± 6.81 mm), LVEF (63.46 ± 11.29% vs. 56.31 ± 11.04%), and LVESD (35.50 2.62 mm vs. 45.20 ± 2.42 mm). Ultrasound-guided PBAV is feasible and achieves good short-term effects in patients with aortic stenosis.

Percutaneous aortic balloon valvuloplasty under echocardiographic guidance solely.

BackgroundPercutaneous balloon aortic valvuloplasty (PBAV) is an alternative to surgical valvulotomy for the treatment of congenital aortic stenosis (AS). This article aims to summarize our preliminary experience on feasibility and safety of PBAV under only echocardiographic guidance in patients with congenital AS.MethodsClinical data from 20 consecutive patients with aortic valve stenosis who underwent PBAV under only echocardiographic guidance at Fuwai Hospital from January 2016 to January 2019 were analyzed retrospectively. Median age of patients was 18.38±15.88 years and 65% of the patients were male. Aortic annulus diameter was 18.40±3.25 mm and balloon diameter was 17.38±3.89 mm, with B/A ratio of 0.93±0.06.ResultsAll the patients successfully underwent PBAV. The peak transaortic gradient (TG) significantly decreased from 81.59±24.91 (range, 58–112) mmHg preoperatively to 36.32±12.83 (range, 16–51) mmHg (P=0.000) immediately post operation, without significant difference in aortic regurgitation (AR). At mean 24.31±17.35 months follow-up, peak TG was 37.06±13.52 (range, 21–58) mmHg which was not significantly different from the immediate postoperative value (P=0.65).ConclusionsIn this retrospective, single center study, systematic use of Doppler echocardiography as only guidance modality for PBAV was feasible and associated with a high success rate and a very low complication rate.

Percutaneous Aortic Valve Intervention in Patients Scheduled for Noncardiac Surgery: A Japanese Multicenter Study

BackgroundThe optimal management of preexisting severe aortic stenosis (AS) in patients undergoing noncardiac surgery (non-CS) remains uncertain. This study aimed to investigate the safety and effectiveness of percutaneous aortic valve intervention (PAVI) in patients with AS before non-CS. MethodsWe analyzed pooled data within a multicenter Japanese registry from 118 patients with severe AS who underwent PAVI before non-CS. Sixty patients underwent percutaneous balloon aortic valvuloplasty (BAV) and 58 patients underwent transcatheter aortic valve replacement (TAVR). The groups' baseline characteristics, perioperative complications, and 30-day mortality and midterm mortality after non-CS were compared. ResultsThe postprocedural mean pressure gradient was higher in the BAV group than in the TAVR group (35.0 ± 11.5 mmHg vs. 11.5 ± 4.8 mmHg, p < 0.001). The non-CS operation risk did not differ between the groups (p = 0.69). One patient in each group experienced a noncardiac death (p = 0.74), and the 30-day mortality rate after non-CS was 1.7%. Heart failure occurred in 2 patients in each group (p = 0.68). One patient in the TAVR group experienced a non-disabling stroke, and no myocardial infarctions occurred. Consequently, the combined adverse events were 5.0% and 6.9% in the 2 groups (p = 0.48). The bleeding rates during the non-CS were similar in both groups (33.3% vs. 25.9%, p = 0.25). There were no differences between the groups regarding midterm mortality (p = 0.60), whereas 53.3% of the patients in the BAV group required invasive treatment of their AS during follow-up. ConclusionsAmong patients with severe AS, PAVI before non-CS reduces the AS severity and may contribute to procedural safety during non-CS.

TCT-691 Clinical Results of Rescue Balloon Valvuloplasty for Severe Aortic Valve Stenosis in Patients With Severe Heart Failure and Cardiogenic Shock in a Community Hospital Without Onsite TAVR Facility

Management of high-risk patients related to severe aortic stenosis (AS) is a challenging topic. The prognosis of patients with AS presenting with therapy-refractory pulmonary edema (RPE) or cardiogenic shock (CS) remains poor. In recent years, the role of percutaneous balloon aortic valvuloplasty (

The Immediate Results of Percutaneous Balloon Aortic Valvuloplasty in Patients with Congenital Aortic Valvular Stenosis

Objective: To assess the immediate-term effectiveness of percutaneous balloon aortic valvuloplasty (PBAV) for congenital aortic stenosis (AS). Design: Early clinical and instrumental evaluation of 34 consecutive PBAV performed from 2001&nbsp;to 2007. Setting:&nbsp; A tertiary referral center for heart diseases (Ibn Al-Bitar Cardiac Center). Patients: Thirty-four patients with congenital valvular AS, twenty-five males and nine females. Interventions: PBAV using Tayshak balloons of different sizes and lengths. Main outcome measures:&nbsp; Doppler and peak to peak pressure gradient (PG) across the aortic valve (AV) before and after valvuloplasty, the percent of PG reduction post dilatation, left ventricular (LV) systolic and diastolic pressures before and after valvuloplasty, number of the aortic cusps, degree of aortic regurgitation (AR) before and after valvuloplasty, left ventricular systolic function before and after valvuloplasty, associated anomalies,&nbsp; and the need for emergency surgery were the main outcome measures. Results: The peak to peak instantaneous PG across the AV was reduced acutely from 102 ± 42.7 (20 - 200) mm Hg to 40 ± 25.5 (10- 140) mm Hg (p&lt;0.001), left ventricular systolic pressure was reduced from 196 ± 48.57 (70 – 280) mm Hg to 133 ± 35.45 (65 – 240) mm Hg (p&lt;0.001) and both are statistically significant. Three patients had inadequate relief of obstruction but in one of them it was mainly due to subaortic obstruction and two patients had severe AR, one of them with acute pulmonary edema and required surgical AV repair. PBAV produced a gradient reduction ≥&nbsp;50% in 29&nbsp;patients, six patients&nbsp;having a residual peak to peak gradient of &gt;50 mm Hg and in one of whom the remaining PG was 70 mm Hg which was mainly subvalvular (50 mm Hg). Six patients had bicuspid AV while the other patients had tricuspid valve. Six had associated anomalies. There was no mortality during the procedure. Severe AR reported in two&nbsp;patients and moderate AR occurred in five patients. One significant complication (acute pulmonary edema) occurred immediately after the dilatation and surgery was done for that patient after few days. Two serious complications occurred during the procedure which responded to routine resuscitation. There was a residual maximum Doppler gradient of &lt;&nbsp;30 mm Hg in 12&nbsp;patients, ≥&nbsp;60 mm Hg in four (one of them had mainly subvalvular gradient) and between 30 to 48 mm Hg in the others. Twenty one patients developed new AR (62%), in fourteen of them (41%) it was mild. Conclusions: PBAV is an effective procedure and offers a good palliation for congenital AS.

The Immediate And Intermediate Results Of Percutaneous Balloon Aortic Valvuloplasty In Patients With Congenital Valvular Aortic Stenosis

Background: Aortic valve stenosis results from minor to severe degrees of aortic valve maldevelopment. This stenosis causes mild to severe obstruction of the left ventricular outflow .&#x0D; Objectives : to study the immediate and intermediate results of percutaneous balloon aortic valvuloplasty in patients with congenital valvular aortic stenosis .&#x0D; Type of the study: A prospective study.&#x0D; Methods: The study was done on thirty five patients with congenital valvular aortic stenosis who had percutaneous balloon aortic valvuloplasty in Ibn Al- Bitar Center for Cardiac Surgery from May 2009 to February 2011.&#x0D; Results: Twenty seven patients were male (77.2%) and 8 patients were female (22.8%), male to female ratio 3.5/ 1, . The aortic valve was bicuspid in 18 patients (51.4%) while 17 patients ( 48.6%) had tricuspid aortic valve. Balloon aortic valvuloplasty was successful in 30 patients (85.7%),. Maximum peak instantaneous Doppler pressure gradient across the aortic valve 24 hours postprocedural echocardiography showed reduction which is statistically significant. New aortic regurgitation had occurred in 15 patients ( 42.8%), it was mild in 9 patients ( 25.6%), moderate in 5 patients ( 14.3%) and severe in 1 patient( 2.9%) which is statistically significant. The follow up of 12.57 ± 3.88 ( 3- 22) months after intervention was done for all patients using echocardiography Doppler study, reveal the maximum peak instantaneous Doppler pressure gradient across the aortic valve was raised which is statistically significant. The aortic regurgitation was present in 18 patients (51.4%) , it was mild in 9 patients (25.7%) , moderate in 6 patients (17.1%) and severe in 3 patients ( 8.6%). No mortality had been reported during the procedure or on follow up.&#x0D; Conclusion: Aortic balloon valvuloplasty is safe and effective procedure in the treatment of congenital valvular aortic stenosis but mild aortic regurgitation is the most common immediate complication of aortic balloon dilatation and progressive aortic regurgitation is a major problem during the intermediate follow up.&#x0D;