[Aortic balloon valvuloplasty in critical aortic stenosis in the newborn and infants].

INTRODUCTION

Balloon valvuloplasty in neonates and small infants with critical aortic stenosis is a palliative procedure. The present report describes the results of the technique in our center.

METHODS

From April 1993 to March 1995, six consecutive patients with critical aortic valve stenosis underwent catheter-balloon valvuloplasty. Their ages ranged from 2 to 120 days old (45.5 +/- 47.5 days). Four patients had associated lesions: 2 had coarctation of the aorta, 1 had ischemic dilated cardiomyopathy and 1 had endocardial fibroelastosis. Percutaneous femoral artery access was used in four cases and axillary artery dissection in two.

RESULTS

The balloon-annulus diameter ratio was 0.92 +/- 0.12. The peak systolic ejection gradient decreased from 66.1 +/- 26.4 to 38 +/- 15.7 mmHg (p < 0.05) and the left ventricle systolic pressure decreased from 136.3 +/- 26.8 to 115 +/- 22.5 mmHg (p < 0.05). There were no mortalities related to the procedure. Both patients who had aortic coarctation developed aortic regurgitation and died after repairing of the coarctation. The patient with endocardial fibroelastosis died during an attempt to perform the Norwood operation (Stage I) and the other patient with ischemic dilated cardiomyopathy survived after cardiac transplantation. The remaining two patients with isolated aortic valve stenosis are currently asymptomatic.

CONCLUSIONS

Catheter-balloon valvuloplasty is an effective procedure in the initial treatment of critical aortic stenosis and may be life saving.