Intermediate-term effectiveness and problems of balloon valvuloplasty for congenital valvular aortic stenosis

We performed percutaneous balloon aortic valvuloplasty (BAV) for 15 patients including 2 critically-ill infants with congenital valvular aortic stenosis (AS). BAV was effective in 13 children (14 trials) except 2 infants. The peak systolic pressure gradient between the left ventricle (LV) and the ascending aorta decreased from 72.9 ± 22.7 to 29.6 ± 16.1 mmHg (p < 0.001). Follow-up cardiac catheterization was performed for 9 children aged one to 3.5 years (1.5 ± 1.1 years) after BAV. Restenosis was found in only one patient, and the effect of BAV lasted long enough (p < 0.01). Aortic regurgitation developed or worsened in 5 of 14 trials immediately after BAV. It developed in 4 children during follow-up period. Any other severe complications were not observed. One patient with critical AS is now in good condition after 2 attempts of BAV. Although cardiac tamponade occurred during the first BAV, we could give him quick rescue by performing BAV under echocardiographic observation. Dilatation by BAV was not sufficient for another infant with critical AS, and acute myocardial infarction (AMI) in the lateral wall of the LV occurred during the BAV procedure. This infant died 3 days after the procedure due to AMI. Retrograde double balloon technique was superior to retrograde single balloon technique. The latter was ineffective in 2 cases because of its inability to fix balloon at the aortic annulus. However, the double-balloon technique was effective in all patients. BAV is effective for AS, and an optional repeat trial may make BAV be the first choice for AS. Although BAV may be effective in neonates and infants with critical AS as an emergency treatment, special attention must be paid during during the procedure.