Document Detail


Neonatal isolated critical aortic valve stenosis: balloon valvuloplasty or surgical valvotomy.
MedLine Citation:
PMID:  16473786     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Open surgical valvotomy and transcatheter balloon valvuloplasty are recognised treatments for neonatal critical aortic stenosis. METHODS: A retrospective analysis was undertaken of all newborns with critical aortic valve stenosis between 1990 and 2000 presenting to a tertiary centre and who required intervention. The initial catheter and surgical intervention was generally based on the preference of the attending cardiologist and the anatomy of the aortic valve and in consultation with the cardiothoracic surgeon. The two groups were therefore not strictly comparable. Twelve were subjected to balloon valvuloplasty and thirteen to surgical valvotomy at a median age of 11 days (2-42 days) and 3.5 days (1-19 days) respectively. There was no significant difference in the timing of the procedure, weight of the infant, aortic annulus or left ventricular dimensions in either group. RESULTS: There was one unrelated hospital death in the balloon group compared to two in the surgical group both of whom had endocardial fibroelastosis. Mild to moderate aortic regurgitation was seen after both procedures. Four patients in the balloon valvuloplasty group, developed femoral artery thrombosis and two had cardiac perforation that resolved with non operative management. The mean Doppler gradient was reduced from 44+/-14 mmHg to 13.4+/-5 mmHg (p<0.01) in the valvuloplasty group compared to a reduction from 42+/-15 mmHg to 27+/-8 mmHg (p<0.05) in the surgical group. Five patients in the balloon group required re-intervention within 3 weeks to 21 months after the initial procedure. Two patients in the surgical group required a pulmonary autograft and Konno Procedure 3 and 5 years following surgical valvotomy. CONCLUSION: Both aortic valvuloplasty and valvotomy offered effective short and medium term palliation. Balloon valvuloplasty patients had a higher re-intervention rate but shorter hospital and intensive care stay, reduced immediate morbidity and were associated with less severe aortic regurgitation.
Authors:
Zarin Zain; Mariutzka Zadinello; Samuel Menahem; Christian Brizard
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Publication Detail:
Type:  Journal Article     Date:  2005-07-25
Journal Detail:
Title:  Heart, lung & circulation     Volume:  15     ISSN:  1443-9506     ISO Abbreviation:  Heart Lung Circ     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-13     Completed Date:  2006-07-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963739     Medline TA:  Heart Lung Circ     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  18-23     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Flemington Road, Parkville, Vic. 3052, Melbourne, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aortic Valve / surgery*
Aortic Valve Insufficiency / etiology
Aortic Valve Stenosis / surgery,  therapy*
Balloon Dilatation / adverse effects,  methods*,  mortality
Echocardiography
Female
Humans
Infant, Newborn
Male
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome

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


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