Document Detail


Usefulness of Doppler echocardiography guidance during balloon aortic valvuloplasty for the treatment of congenital aortic stenosis.
MedLine Citation:
PMID:  17689749     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Few data exist regarding the potential benefits of continuous echocardiographic guidance during balloon aortic valvuloplasty (BAV) for the treatment of congenital aortic stenosis (AS). The objectives of this study were 1) to prospectively evaluate, in a series of consecutive patients with severe AS, the efficacy of BAV guided by Doppler echocardiography (DE) in relieving AS while preventing the appearance of significant aortic regurgitation (AR), and 2) to compare the results obtained by BAV-DE with those obtained in a historical series of patients who underwent BAV without echocardiographic guidance (BAV guided by angiography, BAV-A). METHODS: From 1995 to 2006 a total of 36 consecutive patients with AS (median age 6 years, range, 1 day to 26 years) underwent BAV in our center, with systematic application of continuous DE guidance since 2003. BAV-DE consisted of measuring the aortic annulus, choosing balloon diameters and evaluating the results of each balloon dilation on the basis of DE. RESULTS: Seventeen patients underwent BAV-DE (transthoracic and transesophageal DE in 3 and 14 patients, respectively) with successful transaortic gradient relief in 88% of them. None of the patients complicated with moderate or severe AR. At 17+/-13 months follow-up there had been 3 cardiac events (18%), all of them related to aortic restenosis. BAV-A was associated with longer fluoroscopic times (35 min vs 16 min, p=0.005 after adjusting for age and weight differences between groups) and a higher degree of AR following BAV (>or=2 degrees increase in AR, 32% vs 0%, p=0.045 after adjusting for age and weight). Angiographic measurements of the aortic annulus were higher than those obtained by DE (mean overestimation+2.5+/-1.8 mm, range 0 to +6 mm, p<0.0001). CONCLUSION: BAV-DE provides successful gradient relief of severe AS with lower fluoroscopy time and a lower degree of AR compared to BAV-A. Overestimation of aortic annulus diameters by angiographic measurements might partially explain the high rate of significant AR associated with BAV in the absence of echocardiographic guidance.
Authors:
Christine Bourgault; Josep Rodés-Cabau; Jean-Marc Côté; Philippe Chetaille; George Delisle; Jean Perron; Marc-André Dugas; Marie-Hélène Leblanc; Christine Houde
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-08-08
Journal Detail:
Title:  International journal of cardiology     Volume:  128     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-08     Completed Date:  2008-09-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  30-7     Citation Subset:  IM    
Affiliation:
Institut de Cardiologie de Québec, Hôpital Laval, Quebec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aortic Valve Stenosis / congenital,  therapy*,  ultrasonography
Balloon Dilatation*
Chi-Square Distribution
Child
Child, Preschool
Echocardiography, Doppler*
Female
Humans
Infant
Infant, Newborn
Male
Statistics, Nonparametric
Treatment Outcome
Ultrasonography, Interventional*

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


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