Short- and midterm results of balloon valvuloplasty for valvular aortic stenosis in children

During a 27-month period, 21 consecutive children (aged 0.1 to 15.7 years) with isolated valvular aortic stenosis underwent percutaneous transfemoral balloon valvuloplasty. Ten children had undergone earlier surgical valvulotomy. The indication for treatment was ST-T-segment changes at rest or during bicycle-ergometry, a continuouswave Doppler-derived transvalvular gradient >60 mm Hg or syncope, or a combination. Mean peak systolic left ventricular pressure decreased from 165 ± 19 to 131 ± 19 mm Hg (p < 0.001). Mean end-diastolic left ventricular pressure did not change significantly (12 ± 3 vs 11 ± 5 mm Hg). Mean peak systolic valve gradient decreased from 71 ± 23 to 22 ± 11 mm Hg (p < 0.001). Mean cardiac index remained unchanged (2.9 ± 0.8 vs. 3.0 ± 0.7 liters · min^-1 · m^-2). Aortic valve regurgitation on angiography appeared or increased in 9 patients (up to grade 3 in 3 children). Noninvasive follow-up studies were performed for 2 to 4.2 years (mean 2.8). ST-T changes on the electrocardiogram at rest or during exercise were present in 6 patients before balloon valvuloplasty and had disappeared in all at 6-month follow-up. Reoccurrence of ST-T changes after a longer follow-up was associated with severe valve regurgitation. Syncope was not observed after balloon valvuloplasty. The continuous-wave Doppler gradient decreased from 94 ± 36 to 49 ± 15 mm Hg (p < 0.001). After a follow-up of 2 to 4.2 years (mean 2.8) it remained unchanged (43 ± 13 mm Hg; p = not significant). Aortic regurgitation on echocardiography appeared or increased initially in 11 patients. In some patients after longer follow-up, an additional increase was observed. At the latest follow-up, grade 3 aortic regurgitation was present in 5 patients, 3 of whom underwent valve replacement. These 3 patients had undergone earlier surgical valvulotomy. Except for age, weight and left ventricular end-diastolic pressure before valvuloplasty, there were no differences between the earlier operated and nonoperated patients. Aortic valvuloplasty is effective and postpones surgery in the majority of patients. Occurence or increase of aortic valve regurgitation may be induced, leading to valve replacement in 14% of patients within 2 years.