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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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References

Maskatia, SA, Ing, FF, Justino, H, et al. Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis. Am J Cardiol 2011; 108: 10241028.CrossRefGoogle ScholarPubMed
McElhinney, DB, Lock, JE, Keane, JF, et al. Left heart growth, function, and reintervention after balloon aortic valvuloplasty for neonatal aortic stenosis. Circulation 2005; 111: 451458.CrossRefGoogle ScholarPubMed
Moore, P, Egito, E, Mowrey, H, et al. Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol 1996; 27: 12571263.CrossRefGoogle ScholarPubMed
Reich, O, Tax, P, Marek, J, et al. Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome. Heart 2004; 90: 7076.CrossRefGoogle ScholarPubMed
Sandhu, SK, Lloyd, TR, Crowley, DC, et al. Effectiveness of balloon valvuloplasty in the young adult with congenital aortic stenosis. Catheteriz Cardiovasc Diagn 1995; 36: 122127.CrossRefGoogle Scholar
O’Connor, BK, Beekman, RH, Rocchini, AP, et al. Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study. Circulation 1991; 84: 732738.CrossRefGoogle ScholarPubMed
Egito, ES, Moore, P, O’Sullivan, J, et al. Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm results. J Am College Cardiol 1997; 29: 442447.CrossRefGoogle ScholarPubMed
McCrindle, BW. Independent predictors of immediate results of percutaneous balloon aortic valvotomy in children. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Am J Cardiol 1996; 77: 286293.CrossRefGoogle ScholarPubMed
Petit, CJ, Gao, K, Goldstein, BH, et al. Relation of aortic valve morphologic characteristics to aortic valve insufficiency and residual stenosis in children with congenital aortic stenosis undergoing balloon valvuloplasty. Am J Cardiol 2016; 117: 972979.CrossRefGoogle ScholarPubMed
Fratz, S, Gildein, HP, Balling, G, et al. Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery: a single-center experience of 188 patients after up to 17.5 years of follow-up. Circulation 2008; 117: 12011206.CrossRefGoogle ScholarPubMed
Rocchini, AP, Beekman, RH, Ben Shachar, G, et al. Balloon aortic valvuloplasty: results of the valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 784789.CrossRefGoogle ScholarPubMed
Rao, PS, Thapar, MK, Wilson, AD, et al. Intermediate-term follow-up results of balloon aortic valvuloplasty in infants and children with special reference to causes of restenosis. Am J Cardiol 1989; 64: 13561360.CrossRefGoogle ScholarPubMed
Demkow, M, Ruzyllo, W, Ksiezycka, E, et al. Long-term follow-up results of balloon valvuloplasty for congenital aortic stenosis: predictors of late outcome. J Invasive Cardiol 1999; 11: 220226.Google ScholarPubMed
Petit, CJ, Maskatia, SA, Justino, H, et al. Repeat balloon aortic valvuloplasty effectively delays surgical intervention in children with recurrent aortic stenosis. Catheteriz Cardiovasc Intervent 2013; 82: 549555.Google ScholarPubMed
Galal, O, Rao, PS, Al-Fadley, F, et al. Follow-up results of balloon aortic valvuloplasty in children with special reference to causes of late aortic insufficiency. Am Heart J 1997; 133: 418427.CrossRefGoogle ScholarPubMed
Zaban, NB, Herrmann, JL, Hoyer, MH, et al. Short- and intermediate-term results of balloon aortic valvuloplasty and surgical aortic valvotomy in neonates. Cardiol Young 2020; 4: 489492.CrossRefGoogle Scholar
Wunderlich, W, Roehrig, B, Fischer, F, et al. The imact of vessel and catheter position of the measurement accuracy in catheter-based quantitative coronary angiography. Int J Card Imag 1998; 14: 217227.CrossRefGoogle Scholar
Petit, CJ, Glatz, AC, Qureshi, AM, et al. Outcomes after decompression of the right ventricle in infants with pulmonary atresia with intact ventricular septum are associated with degree of tricuspid regurgitation: results from the congenital catheterization research collaborative. Circ Cardiovasc Interv. 2017; 10 10.1161/CIRCINTERVENTIONS.116.004428.CrossRefGoogle Scholar
Petit, CJ, Qureshi, AM, Glatz, AC, et al. Comprehensive comparative outcomes in children with congenital heart disease: the rationale for the congenital catheterization research collaborative. Congenit Heart Dis 2019; 14: 341349.CrossRefGoogle ScholarPubMed
Quinones, MA, Douglas, PS, Foster, E, et al. ACC/AHA clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. J Am Coll Cardiol 2003; 41: 687708.Google Scholar
Yeager, SB. Balloon selection for double balloon valvotomy. J Am Coll Cardiol 1987; 9: 467468.CrossRefGoogle ScholarPubMed
Radtke, W, Keane, JF, Fellows, KE, et al. Percutaneous balloon valvotomy of congenital pulmonary stenosis using oversized balloons. J Am Coll Cardiol. 1986; 8: 909915.CrossRefGoogle ScholarPubMed
Maskatia, SA, Justino, H, Ing, FF, et al. Aortic valve morphology is associated with outcomes following balloon valvuloplasty for congenital aortic stenosis. Catheteriz Cardiovasc Intervent 2013; 81: 9095.CrossRefGoogle ScholarPubMed
Sholler, GF, Keane, JF, Perry, SB, et al. Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome. Circulation 1988; 78: 351360.CrossRefGoogle Scholar
Solymar, L, Sudow, G, Berggren, H, et al. Balloon dilation of stenotic aortic valve in children. An intraoperative study. J Thoracic Cardiovasc Surg. 1992; 104: 17091713.CrossRefGoogle ScholarPubMed
Crespo, D, Miro, J, Vobecky, SJ, et al. Experience in a single centre with percutaneous aortic valvoplasty in children, including those with associated cardiovascular lesions. Cardiol Young. 2009; 19: 372382.CrossRefGoogle Scholar
Gao, K, Sachdeva, R, Goldstein, BH, et al. Aortic valve morphology correlates with left ventricular systolic function and outcome in children with congenital aortic stenosis prior to balloon aortic valvuloplasty. J Invasive Cardiol. 2016; 28: 381388.Google ScholarPubMed
Zeevi, B, Keane, JF, Castaneda, AR, et al. Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy. Circulation 1989; 80: 831839.CrossRefGoogle ScholarPubMed
Beekman, 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: 11721176.CrossRefGoogle ScholarPubMed
Moore, P, Egito, E, Mowrey, H, et al. Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol. 1996; 27: 12571263.CrossRefGoogle ScholarPubMed
Badger, SA, Arya, N, Loan, W, et al. Evaluation of angiography as the sole imaging study for the proximal aortic neck prior to EVAR. Ulster Med J 2009; 78: 166170.Google ScholarPubMed
Chubb, H, Ward, A, Worme, A, et al. Correlation of echocardiographic and angiographic measurements of the pulmonary valve annulus in pulmonary stenosis. Catheter Cardiovasc Interv. 2014; 84: 192196.CrossRefGoogle ScholarPubMed
Pathak, SH, Pockett, CR, Moore, JW, et al. Effect of balloon: annulus ratio on incidence of pulmonary insufficiency following valvuloplasty. Congenit Heart Dis. 2016; 11: 415419.CrossRefGoogle ScholarPubMed