Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
J Interv Cardiol. 2021 Jan 12;2021:6681693. doi: 10.1155/2021/6681693. eCollection 2021.
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.
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.
During the study period, a total of thirty patients, newborns ( = 15) and infants/children ( = 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.
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.
主动脉瓣狭窄占先天性心脏病的 3-6%。球囊主动脉瓣成形术（BAV）是许多中心的首选治疗介入方法。然而，大多数报告的数据来自发达国家。
我们进行了一项回顾性单中心研究，纳入了 2005 年 1 月至 2016 年 1 月期间在我们的三级中心因经皮 BAV 而入院的连续合格的新生儿和婴儿先天性主动脉瓣狭窄患者。我们评估了在发展中国家的三级中心，使用 BAV 治疗先天性主动脉瓣狭窄（CAS）的短期和中期结果。同样，我们将这些结果与发达国家的报告进行了比较。
在研究期间，共有 30 名患者，新生儿（ = 15）和婴儿/儿童（ = 15）接受了 BAV。56%的患者存在左心室收缩功能障碍。单纯性 AS 存在于 19 例患者（63%）中。11 例患者存在合并畸形（37%）：7 例（21%）存在主动脉缩窄，2 例（6%）存在限制性室间隔缺损，1 例存在轻度埃布斯坦畸形，1 例存在肖恩综合征，1 例存在二尖瓣裂。BAV 与围手术期或即刻术后死亡率无关。在瓣成形术后，仅两名患者（7%）出现中重度主动脉瓣反流。其余 93%的患者出现无至轻度主动脉瓣反流。一名患者在手术后三个月死亡。平均随访 7 年后，20 名患者（69%）出现中重度主动脉瓣反流，4 名患者（13%）需要手术干预。1 年和 10 年的随访中，主动脉瓣再次干预的 Kaplan-Meier 无事件生存率分别为 97%和 87%。
根据发展中国家三级中心的结果，BAV 是一种有效且安全的治疗方法，其并发症发生率低，与发达国家报告的数据相当。
