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Criteria for selection of balloon valvoplasty for treatment of aortic stenosis in neonates

Published online by Cambridge University Press:  19 August 2008

Andrea Donti ,
Marco Bonvicini ,
Gaetano Gargiulo ,
Guido Frascaroli  and
Fernando M. Picchio
Andrea Donti*
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Marco Bonvicini
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Gaetano Gargiulo
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Guido Frascaroli
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Fernando M. Picchio
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
*
Dr. Andrea Donti, Istituto di Malattie Cardiovascolari, Universita' degli Studi di Bologna, Via Massarenti N°9, Policlinico S. Orsola, 40138 Bologna, Italy. Fax. 39 51 344859
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Summary

In 10 neonates with critical aortic stenosis who were treated with balloon dilation, we investigated retrospectively the predictive value for mortality of three echocardiographic parameters: early diastolic mitral valvar diameter, left ventricular end-diastolic diameter, and diameter of the aortic root. Valvoplasty was technically successful in each patient and the peak systolic ejection gradient decreased from 85±42 to 22±13 mm Hg, but clinical success was achieved in only six neonates, with four dying. The diameter of the aortic root was similar in survivors and non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The association of a mitral valvar diameter equal to, or less than, 9 mm with a left ventricular end-diastolic diameter equal to, or less than, 14 mm identified clearly all those who did not survive. In the future, we will recommend patients with these anatomical features for primary Norwood palliation. Neonates with a mitral valvar diameter equal to or greater than 12 mm and a left ventricular end-diastolic diameter equal to or greater than 17 mm, in contrast, are good candidates for balloon dilation. All our patients with these anatomical features survived and are doing well at follow-up (30±14.8 months). Simple echocardiographic measurements, therefore, can help in predicting outcome and choosing the best treatment in neonates with critical aortic stenosis.

Keywords

Congenital aortic valvar stenosisneonatesaortic balloon dilationechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 1 , January 1995 , pp. 31 - 35
Copyright
Copyright © Cambridge University Press 1995

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References

Keane, JF, Bernahrd, WE, Nadas, AS.Aortic stenosis surgery in infancy. Circulation 1975; 52: 1138–1143.CrossRefGoogle ScholarPubMed
Lakier, JB, Lewis, AB, Heymann, MA, Stanger, P, Hoffman, JIE, Rudolph, AM.Isolated aortic stenosis in neonate: natural history and hemodynamic considerations. Circulation 1974; 50: 801–808.CrossRefGoogle ScholarPubMed
Trinkle, JK, Grover, LF, Atom, KV.Closed aortic valvotomy in infants: late results. J Thorac Cardiovasc Surg 1978; 76: 198–201.CrossRefGoogle ScholarPubMed
Villain, E, Planchè, C, Batisse, A, Kachaner, J, Fermont, L, Sidi, D, Lamberti, A, Piechaud, JF.Traitement des stenoses aortiques graves du nourrison par valvolotomie transventric-ulaire. Arch Mal Coeur 1982; 8: 877–884.Google Scholar
Sandor, GGS, Olley, PM, Trusler, GA, Williams, WG, Rowe, RD, Morch, JE.Long-term follow-up ofpatients aftervalvotomy for congenital valvar aortic stenosis in children. J Thorac Cardiovasc Surg 1980; 80: 171–176.CrossRefGoogle Scholar
Kugler, JD, Campbell, E, Vargo, TA, McNamara, DG, Hallmann, GL, Cooley, DA.Results of aortic valvotomy in infants with isolated aortic valvular stenosis. J Thorac Cardiovasc Surg 1979; 78: 553–558.CrossRefGoogle ScholarPubMed
Edmunds, LH, Wagner, HR, Hetmann, MA.Aortic valvulotomy in neonates. Circulation 1980; 61: 421–427.CrossRefGoogle ScholarPubMed
Wheller, JJ, Hosier, DM, Teske, DW, Craenen, JM, Kilman, JW.Results of operation for aortic valve stenosis in infants, children and adolescents. J Thorac Cardiovas Surg 1988; 96: 474–477.CrossRefGoogle ScholarPubMed
Vogel, M, Benson, LN, Burrows, P, Smallhorn, JF, Freedom, RM.Balloon dilatation of congenital aortic valve stenosis in infants and children: short-term and intermediate results. Br HeartJ 1989; 62: 148–153.CrossRefGoogle ScholarPubMed
Rocchini, AP, Beekman, RH, Shachar, GB, Benson, L, Schwartz, D, Kan, JS.Results of the valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 784–789.CrossRefGoogle ScholarPubMed
Zeevi, B, Keane, JF, Castaneda, 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
Kasten-Sportes, CH, Piechaud, JF, Sidi, D, Kachaner, J.Percutaneous balloon valvuloplasty in neonates with critical aortic stenosis. J Am Coll Cardiol 1989; 13: 1101–1105.CrossRefGoogle ScholarPubMed
Fischer, DR, Ertedgui, JA, Park, SC, Siewers, RD, Del Nido, PJ.Carotid artery approach for balloon dilation of aortic valve stenosis in the neonate: a preliminary report. J Am Coll Cardiol 1990; 15: 1633–1636.CrossRefGoogle ScholarPubMed
Beckman, RH, Rocchini, AP, Andes, A.Balloon valvuloplasty for critical aortic stenosis in the newborn: influence of new catheter technology. J Am Coll Cardiol 1991; 17: 1172–1176.CrossRefGoogle Scholar
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
Bailey, LL, Nehlsen-Cannarella, SL, Doroshow, RW, Jacobson, JG, Martin, RD, Allard, MW, Hyde, MR, Dang Bui, RH, Petry, E.Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndorme. N Engl J Med 1986; 315: 949–951.CrossRefGoogle Scholar
Leung, MP, McKay, R, Smith, A, Anderson, RH, Arnold, R.Critical aortic stenosis in early infancy. Anatomic and echocardiographic substrates of successful open valvotomy. J Thorac Cardiovasc Surg 1991; 101: 526–535.CrossRefGoogle ScholarPubMed
Parsons, MK, Moreau, GA, Graham, TP, Johns, JA, Boucek, RJ Jr. Echocardiographic estimation of critical left ventricular size in infants with isolated aortic valve stenosis. J Am Coll Cardiol 1991; 18: 1049–1055.CrossRefGoogle ScholarPubMed
Norwood, WI.Hypoplastic left heart syndrome. Cardiol Clinics 1989; 7: 377–385.CrossRefGoogle ScholarPubMed