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Echocardiographic versus angiographic measurement of the aortic valve annulus in children undergoing balloon aortic valvuloplasty: method affects outcomes

Published online by Cambridge University Press:  14 October 2020

George T. Nicholson*
Affiliation:
Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN, USA
Bryan H. Goldstein
Affiliation:
The Heart Institute, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Kevin Gao
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Ritu Sachdeva
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Sean M. Lang
Affiliation:
The Heart Institute, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Scott Gillespie
Affiliation:
Department of Biostatistics, Emory University School of Medicine, Atlanta, GA, USA
Sung-in H. Kim
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Christopher J. Petit
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: George T. Nicholson, MD, Assistant Professor of Pediatrics, Vanderbilt University School of Medicine, 220 Children’s Way, Nashville, TN 37232, USA. Tel: +1 615 322 7447; Fax: +1 615 322 2210. E-mail: [email protected]

Abstract

Objective:

Operators are mindful of the balloon-to-aortic annulus ratio when performing balloon aortic valvuloplasty. The method of measurement of the aortic valve annulus has not been standardised.

Methods and results:

Patients who underwent aortic valvuloplasty at two paediatric centres between 2007 and 2014 were included. The valve annulus measured by echocardiography and angiography was used to calculate the balloon-to-aortic annulus ratio and measurements were compared. The primary endpoint was an increase in aortic insufficiency by ≥2 degrees. Ninety-eight patients with a median age at valvuloplasty of 2.1 months (Interquartile range (IQR): 0.2–105.5) were included. The angiographic-based annulus was 8.2 mm (IQR: 6.8–16.0), which was greater than echocardiogram-based annulus of 7.5 mm (IQR: 6.1–14.8) (p < 0.001). This corresponded to a significantly lower angiographic balloon-to-aortic annulus ratio of 0.9 (IQR: 0.9–1.0), compared to an echocardiographic ratio of 1.1 (IQR: 1.0–1.1) (p < 0.001). The degree of discrepancy in measured diameter increased with smaller valve diameters (p = 0.041) and in neonates (p = 0.044). There was significant disagreement between angiographic and echocardiographic balloon-to-aortic annulus ratio measures regarding “High” ratio of >1.2, with angiographic ratio flagging only 2/12 (16.7%) of patients flagged by echocardiographic ratio as “High” (p = 0.012). Patients who had an increase in the degree of aortic insufficiency post valvuloplasty, only 3 (5.5%) had angiographic ratio > 1.1, while 21 (38%) had echocardiographic ratio >1.1 (p < 0.001). Patients with resultant ≥ moderate insufficiency more often had an echocardiographic ratio of >1.1 than angiographic ratio of >1.1 There was no association between increase in balloon-to-aortic annulus ratio and gradient reduction.

Conclusions:

Angiographic measurement is associated with a greater measured aortic valve annulus and the development of aortic insufficiency. Operators should use caution when relying solely on angiographic measurement when performing balloon aortic valvuloplasty.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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