Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-27T00:54:22.910Z Has data issue: false hasContentIssue false
  • English
  • Français

Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry

Published online by Cambridge University Press:  19 August 2008

Blair V. Robinson ,
Grazyna Brzezinska-Rajszys ,
Howard S. Weber ,
Joanna Ksiazyk ,
F. Jay Fricker ,
Donald R. Fischer  and
José A. Ettedgui
Blair V. Robinson*
Affiliation:
University of North Carolina, Chapel Hill, NC
Grazyna Brzezinska-Rajszys
Affiliation:
Children's Memorial Health Institute, Warsaw, Poland
Howard S. Weber
Affiliation:
Penn State University Children's Hospital, Hershey, PA
Joanna Ksiazyk
Affiliation:
University of North Carolina, Chapel Hill, NC
F. Jay Fricker
Affiliation:
University of Florida, Gainesville, FL
Donald R. Fischer
Affiliation:
Children's Hospital of Pittsburgh, Pittsburgh, PA.
José A. Ettedgui
Affiliation:
Children's Hospital of Pittsburgh, Pittsburgh, PA.
*
Blair Robinson, MD, Pediatric Cardiology Department, 311 Burnett-Womack Bldg. CB# 7220, Chapel Hill, NC 27599–7220. Tel: (919) 966–4601; Fax: (919) 966–6894; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The purpose of this study was to evaluate the short and intermediate term results of infants who have undergone balloon aortic valvotomy from the carotid arterial approach, and to identify risk factors in those infants who had a poor outcome.

Methods

Between 1988 and 1999, balloon aortic valvotomy was attempted at four centres in 95 infants with severe aortic stenosis. Echocardiographic and hemodynamic data, and outcome, were analysed retrospectively.

Results

Valvotomy was accomplished in 92 of the 95 infants, with a median age of 5 days, a range from 0 to 191 days, and weighing 3.4 kg, with a range from 1.0 to 6.5 kg. Major procedural complications occurred in 10 infants. Post-procedural aortic regurgitation was severe in 5 patients. There were 13 early deaths, and 4 late deaths. The period of mean follow-up has been 2.1 years, with a range from 0 to 9.3 years. The actuarial survival at 3 years was 76 ± 6%. Further interventions were needed in 19 patients, giving a 3-year freedom from reintervention of 67 ± 6%. The 51 infants who were duct-dependent were further analyzed, and found to have a higher mortality (38%) compared to those infants not dependent on the arterial duct (5%). Risk factors for a poor outcome in the duct-dependent infants were mitral stenosis (p<0.005), a left ventricle which did not form the cardiac apex (p<0.005), and an aortic valve with a diameter of less than 6 mm (p<0.05).

Conclusions

This multi-centric registry shows good results in the intermediate term for treating infants with severe aortic valvar stenosis with balloon valvotomy through a carotid arterial cutdown. Infants dependent on prostaglandin had a worse outcome, especially if they had any of the identified risk factors.

Keywords

Balloonvalvoplastystenosiscongenital cardiac malformations
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 3 , May 2000 , pp. 225 - 232
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Mody, MR, Nadas, AS, Bernhard, WF. Aortic Stenosis in infants. N Engl J Med 1967; 276: 832–838.CrossRefGoogle ScholarPubMed
2.Lakier, JB, Lewis, AB, Heymann, MA, Stanger, P, Hoffman, JIE, Rudolph, AM. Isolated aortic stenosis in the neonate. Natural history and hemodynamic considerations. Circulation 1974; 50: 801–808.CrossRefGoogle ScholarPubMed
3.Keane, JF, Bernhard, WF, Nadas, AS. Aortic stenosis surgery in infancy. Circulation 1975; 52: 1138–1143.CrossRefGoogle ScholarPubMed
4.Mosca, RS, Schwartz, SM, Beckman, RH, Bove, EL. Critical aortic stenosis in the neonate. J Thorac Cardiovasc Surg 1995; 109: 147–153.CrossRefGoogle ScholarPubMed
5.Sandor, GGS, Olley, PM, Trusler, GA, Williams, WG, Rowe, RDMorch, JE. Long-term follow-up of patients after vaivotomy for congenital vaivular aortic stenosis in children. J Thorac Cardiovasc Surg 1980; 80: 171–176.CrossRefGoogle ScholarPubMed
6.Pelech, AN, Dyck, JD, Trusler, GA et al. , Critical aortic stenosis. Survival and management. J Thorac Cardiovasc Surg 1987; 94: 510–517.CrossRefGoogle ScholarPubMed
7.Ettedgui, JA, Taliman-Eddy, T, Neches, WH et al. , Long-term results of survivors of surgical vaivotomy for severe aortic stenosis in early infancy. J Thorac Cardiovasc Surg 1992; 104: 1714–1720.CrossRefGoogle ScholarPubMed
8.Lababidi, Z, Weinhaus, L. Successful balloon vaivulopiasty for neonatal critical aorticstenosis. Am Heart J 1986; 12: 913–916.CrossRefGoogle Scholar
9.Zeevi, B, Keane, JF, Casteneda, AR, Perry, SB, Lock, JE. Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy. Circulation 1989; 80: 831–839.CrossRefGoogle ScholarPubMed
10.Gatzoulis, MA, Rigby, ML, Shinebourne, EA, Redington, AN. Contemporary results of balloon valvuloplasty and surgical vaivotomy for congenital aortic stenosis. Arch Dis Child 1995; 73: 66–69.CrossRefGoogle ScholarPubMed
11.Egito, EST, Moore, P, O'Sullivan, J, Colan, S, Perry, SB, Lock, JE, Keane, JF. Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm results. J Am Coil Cardiol 1997; 29: 442–447.CrossRefGoogle ScholarPubMed
12.Fellows, KE, Radtke, W, Keane, JF, Lock, JE. Acute complications of catheter therapy for congenital heart disease. Am J Cardiol 1987; 60: 679–683.CrossRefGoogle ScholarPubMed
13.Cassidy, SC, Klaus, GS, Van Hare, GF, Stanger, P, Teirel, DE. Complications of pediatric cardiac catheterization: a 3-year study. J Am Coil Cardiol 1992; 19: 1285–1293.CrossRefGoogle Scholar
14.Vermilion, RPSnider, AR, Bengur, AR, Beckman, RH. Doppler evaluation of femoral arteries in children after aorric balloon valvuloplasry or coarctation balloon angiopiasty. Pediatr Cardiol 1993; 14: 13–18.CrossRefGoogle ScholarPubMed
15.Beckman, RH, Rocchini, AP, Andes, A. Balloon valvuloplasty for critical aortic stenosis in the newborn, Influence of new catheter technology. J Am Coil Cardiol 1991; 17: 1172–1176.CrossRefGoogle Scholar
16.Fischer, DR, Erredgui, JA, Park, SC, Siewers, RD, Nido, PJD. Carotid artery approach for balloon dilatation of aorric valve stenosis in the neonate: a preliminary report. J Am Coll Cardiol 1990; 15: 1633–1636.CrossRefGoogle ScholarPubMed
17.Giusti, S, Borghi, A, Redaelli, S, Bonhoeffer, P, Spadoni, I, Macri, R, Carminati, M. The carotid arterial approach for balloon dilation of critical aorric stenosis in neonates-immediate results and follow-up. Cardiol Young 1995; 5: 155–160.CrossRefGoogle Scholar
18.Macno, Y, Akagi, T, Hashino, K, Ishii, M, Sugimura, T, Takagi, J, Suzuki, K, Kato, H. Carotid artery approach to balloon aortic valvuloplasty in infants with critical aortic valve stenosis. Pediarr Cardiol 1997; 18: 288–291.Google Scholar
19.Perry, GJ, Heimecke, F, Nanda, NC, Byard, C, Soto, B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coil Cardiol 1987; 9: 952–959.CrossRefGoogle ScholarPubMed
20.Sellers, RD, Levy, MJ, Amplarz, K, Lillehei, CW. Left retrograde cardioangiography in acquired cardiac disease. Am J Cardiol 1964; 14: 437–447.CrossRefGoogle ScholarPubMed
21.Weber, HS, Mart, CR, Kupferschmid, J, Myers, JL, Cyran, SE. Transcarotid balloon valvuloplasty with continuous trans esophageal echocardiographic guidance for neonatal critical aortic valve stenosis: an alternative to surgical palliation. PediatrCardiol 1998; 19: 212–217.Google Scholar
22.Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.CrossRefGoogle ScholarPubMed