Document Detail


Aortic wall injury as a complication of neonatal aortic valvuloplasty: incidence and risk factors.
MedLine Citation:
PMID:  20031655     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transcatheter balloon aortic valvuloplasty for critical aortic stenosis in neonates is routinely performed without recognized complication. Aortic wall injury has rarely been observed after balloon aortic valvuloplasty, although the incidence of this complication is unstudied. We reviewed single-center data to determine the incidence of aortic injury during balloon aortic valvuloplasty and to identify risk factors. METHODS AND RESULTS: This retrospective study included all patients <2 months of age who underwent balloon aortic valvuloplasty at our institution from 1985 to 2007. We defined aortic wall injury as an intimal flap, dissection, or vessel rupture as diagnosed by angiography, echocardiography, or direct surgical or postmortem inspection. Primary imaging data were reviewed, as were all procedural and pathology reports, to identify cases of aortic wall injury. Patient and procedural variables were analyzed. Of 187 procedures performed, 28 procedures resulted in aortic wall injury (15%). Injury was recognized at the time of the procedure in only 16 cases (57%). Intimal flaps occurred most commonly in the distal ascending aorta (n=13), most often involving the greater curvature. In multivariate analysis, severe ventricular dysfunction at the time of the procedure (odds ratio, 2.8; P=0.02), greater number of balloon dilation attempts per procedure (odds ratio, 1.5; P=0.005), and novice interventional staff (odds ratio, 2.5; P=0.05) were associated with aortic injury. Incidence of injury was not different in the recent era compared with earlier experience. CONCLUSIONS: Aortic wall injury, specifically creation of an intimal flap, is an underrecognized complication of neonatal balloon aortic valvuloplasty, occurring in 15% of cases even in the recent era. Only severe ventricular dysfunction, greater number of balloon dilations, and novice staff were associated with injury. The clinical sequelae of aortic wall injury remain incompletely understood.
Authors:
David W Brown; Erin C Chong; Kimberlee Gauvreau; John F Keane; James E Lock; Audrey C Marshall
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  1     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2009-12-24     Completed Date:  2010-06-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  53-9     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Children's Hospital Boston, Harvard Medical School, MA 02115, USA. david.brown@cardio.chboston.org
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MeSH Terms
Descriptor/Qualifier:
Aorta / injuries*,  ultrasonography
Aortic Rupture / epidemiology,  etiology*,  radiography,  ultrasonography
Aortic Valve Stenosis / physiopathology,  therapy*
Balloon Dilatation / adverse effects*,  instrumentation,  methods
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Professional Practice
Retrospective Studies
Risk Factors
Survival Analysis
Ventricular Dysfunction

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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