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Pfeifer J, Rentzsch A, Poryo M, Abdul-Khaliq H. Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle. J Cardiovasc Dev Dis 2024; 11:156. [PMID: 38786978 PMCID: PMC11122585 DOI: 10.3390/jcdd11050156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Congenital critical aortic valve stenosis (CAVS) is a life-threatening disease requiring urgent treatment. First-line therapy is still controversial. The aim of our study was (1) to analyze retrospectively the patients of our institution who underwent balloon aortic valvuloplasty (BAV) due to CAVS and (2) describe the techniques for improved feasibility of intervention using microcatheters and retrieval loops. Twelve patients underwent 23 BAVs: 1 BAV was performed in 3 patients, 2 BAVs were performed in 7 patients, and 3 BAVs were performed in 2 patients. The peak trans-valvular pressure gradient (Δp) and left ventricular shortening fraction (LVSF) improved significantly in the first two interventions. In the first BAV, Δp decreased from 73.7 ± 34.5 mmHg to 39.8 ± 11.9 mmHg (p = 0.003), and the LVSF improved from 22.3 ± 13.5% to 31.6 ± 10.2% (p = 0.001). In the second BAV, Δp decreased from 73.2 ± 33.3 mmHg to 35.0 ± 20.2 mmHg (p < 0.001), and the LVSF increased from 26.7 ± 9.6% to 33.3 ± 7.4% (p = 0.004). Cardiac surgery during the neonatal period was avoided for all children. The median time to valve surgery was 5.75 years. Few complications occurred, namely mild-to-moderate aortic regurgitation, one remediable air embolism, and one intimal injury to the ascending aorta. We conclude that BAV is a successful emergency treatment for CAVS, resulting in left ventricular relief, clinical stabilization, and a time gain until cardiac surgery.
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Affiliation(s)
- Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany
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Ross F, Everhart K, Latham G, Joffe D. Perioperative and Anesthetic Considerations in Pediatric Valvar and Subvalvar Aortic Stenosis. Semin Cardiothorac Vasc Anesth 2023; 27:292-304. [PMID: 37455142 DOI: 10.1177/10892532231189933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Aortic stenosis (AS) is a common form of left ventricular outflow tract obstruction (LVOTO) in children with congenital heart disease. This review specifically considers the perioperative features of valvar (VAS) and subvalvar AS (subAS) in the pediatric patient. Although VAS and subAS share some clinical features and diagnostic approaches, they are distinct clinical entities with separate therapeutic options, which range from transcatheter intervention to surgical repair. We detail the pathophysiology of AS and highlight the range of treatment strategies with a focus on anesthetic considerations for the care of these patients before, during, and after intervention.
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Affiliation(s)
- Faith Ross
- Department of Anesthesiology and Pain Medicine, Division of Pediatric Cardiac Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kelly Everhart
- Department of Anesthesiology and Pain Medicine, Division of Pediatric Cardiac Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Greg Latham
- Department of Anesthesiology and Pain Medicine, Division of Pediatric Cardiac Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Denise Joffe
- Department of Anesthesiology and Pain Medicine, Division of Pediatric Cardiac Anesthesiology, Seattle Children's Hospital, Seattle, WA, USA
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Papneja K, Blatman ZM, Kawpeng ID, Wheatley J, Oscé H, Li B, Lafreniere-Roula M, Fan CPS, Manlhiot C, Benson LN, Mertens L. Trajectory of Left Ventricular Remodeling in Children With Valvar Aortic Stenosis Following Balloon Aortic Valvuloplasty. Circ Cardiovasc Imaging 2022; 15:e013200. [PMID: 35041447 PMCID: PMC8772052 DOI: 10.1161/circimaging.121.013200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Aortic valve stenosis is the most common type of congenital left ventricular (LV) outflow tract obstruction. Balloon aortic valvuloplasty (BAV) has become the first-line treatment pathway in many centers. Our aim was to assess the trajectory of LV remodeling following BAV in children and its relationship to residual aortic stenosis (AS) and insufficiency (AI). Methods: Children <18 years of age who underwent BAV for isolated aortic stenosis from 2004 to 2012 were eligible for inclusion. Those with AI before BAV, other complex congenital heart lesions, or <2 accessible follow-up echocardiograms were excluded. Baseline and serial echocardiographic data pertaining to aortic valve and LV size and function were retrospectively collected through December 2017 or the first reintervention. Longitudinal data was assessed using per-patient time profiles with superimposed trend lines using locally estimated scatterplot smoothing. Associations with reintervention or death were also evaluated. Results: Among the 98 enrolled children, the median (interquartile range) age at BAV was 2.8 months (0.2–75). The median (interquartile range) follow-up was 6.8 years (1.9–9.0). Children with predominantly residual AI (n=11) demonstrated progressive increases in their LV end-diastolic dimension Z score within the first 3 years after the BAV, followed by a plateau (P<0.001). Their mean LV circumferential and longitudinal strain values remained within the normal range but lower than in the non-AI group (P<0.001 and P=0.001, respectively). Children with predominantly residual aortic stenosis (n=44) had no changes in LV dimensions but had a rapid early increase in mean LV circumferential and longitudinal strain. The cumulative proportion (95% CI) of reintervention at 5 years following BAV was 33.7% (23.6%–42.4%). Conclusions: Our study demonstrates that LV remodeling occurs mainly during the first 3 years in children with predominantly residual AI after BAV, with no subsequent significant functional changes over the medium term. These data improve our understanding of expected patient trajectories and thus may inform decisions on the timing of reintervention.
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Affiliation(s)
- Koyelle Papneja
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.).,Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, CA (K.P.)
| | - Zachary M Blatman
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Ian D Kawpeng
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Jacqueline Wheatley
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Hanne Oscé
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Boning Li
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Myriam Lafreniere-Roula
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Chun P S Fan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Cedric Manlhiot
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Lee N Benson
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada (K.P., Z.M.B., I.D.K., J.W., H.O., B.L., M.L.-R., C.P.S.F., C.M., L.N.B., L.M.)
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Zhu Y, Hu R, Zhang W, Yu X, Dong W, Sun Y, Zhang H. Surgical and Transcatheter Treatments in Children with Congenital Aortic Stenosis. Thorac Cardiovasc Surg 2020; 70:10-17. [PMID: 32886929 DOI: 10.1055/s-0040-1715437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND For patients with congenital aortic valve stenosis (AVS), comprehensive analysis of surgical aortic valvuloplasty (SAV) or balloon dilation (BD) is scarce and remains controversial. METHODS This study reviewed AVS data (aortic peak gradient, aortic insufficiency, and survival and reoperation) for patients who were suitable for biventricular repair at our center in 2008 to 2018. Patients were categorized into two subgroups based on age (≤3 or >3 months). RESULTS A total of 194 patients were treated, including 124 with SAV and 70 with BD. Resulting data revealed that residual aortic gradient at discharge was worse for BD (p = 0.001). While for patients younger than 3 months, the relief of AVS was comparable between the two groups (p = 0.624). There was no significant difference in time-related survival between the two groups (log-rank p = 0.644). Multivariate analysis demonstrated that preoperative left ventricular end-diastolic dimension predicted early death (p = 0.045). Survival in the two groups after 10 years was 96.8% in SAV and 95.7% in BD (p = 0.644). Freedom from reoperation after 10 years was 58.1% in SAV and 41.8% in BD patients (p = 0.01). There was no significant difference in freedom from reoperation between SAV and BD in patients younger than 3 months (p = 0.84). Multivariate analysis indicated that residual aortic peak gradient was predictive of reoperation (p = 0.038). CONCLUSION Both methods achieved excellent survival outcomes at our center. SAV achieved superior gradient reduction and minimized the necessity for reoperation. For patients younger than 3 months, BD rivaled SAV both in aortic stenosis relief and freedom from reoperation.
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Affiliation(s)
- Yifan Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiafeng Yu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Dong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanjun Sun
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Dorobantu DM, Taliotis D, Tulloh RM, Sharabiani MTA, Mohamed Ahmed E, Angelini GD, Stoica SC. Surgical versus balloon valvotomy in neonates and infants: results from the UK National Audit. Open Heart 2019; 6:e000938. [PMID: 30997128 PMCID: PMC6443132 DOI: 10.1136/openhrt-2018-000938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 12/27/2022] Open
Abstract
Objective There are conflicting data on choosing balloon aortic valvoplasty (BAV) or surgical aortic valvotomy (SAV) in neonates and infants requiring intervention for aortic valve stenosis. We aim to report the outcome of both techniques based on results from the UK national registry. Methods This is a retrospective study, including all patients under 1 year undergoing BAV/SAV between 2000 and 2012. A modulated renewal approach was used to examine the effect of reinterventions on outcomes. Results A total of 647 patients (488 BAV, 159 SAV, 292 neonates) undergoing 888 aortic valve procedures were included, with a median age of 40 days. Unadjusted survival at 10 years was 90.6% after initial BAV and 84.9% after initial SAV. Unadjusted aortic valve replacement (AVR) rate at 10 years was 78% after initial BAV and 80.3% after initial SAV. Initial BAV and SAV had comparable outcomes at 10 years when adjusted by covariates (p>0.4). AVR rates were higher after BAV and SAV reinterventions compared with initial valvoplasty without reinterventions (reference BAV, HR=3 and 3.8, respectively, p<0.001). Neonates accounted for 29/35 of early deaths after the initial procedure, without significant differences between BAV and SAV, with all late outcomes being worse compared with infants (p<0.005). Conclusions In a group of consecutive neonates and infants, BAV and SAV had comparable survival and freedom from reintervention as initial procedures and when performed as reinterventions. These findings support a treatment choice based on patient characteristics and centre expertise, and further research into the best patient profile for each choice.
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Affiliation(s)
- Dan Mihai Dorobantu
- Departments of Cardiac Surgery and Cardiology, Bristol Royal Hospital for Children, Bristol, UK.,Cardiology Department, "Prof. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Demetris Taliotis
- Departments of Cardiac Surgery and Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Robert Michael Tulloh
- Departments of Cardiac Surgery and Cardiology, Bristol Royal Hospital for Children, Bristol, UK.,Departments of Cardiac Surgery and Cardiology, Bristol Heart Institute, Bristol, UK
| | | | | | - Gianni Davide Angelini
- Departments of Cardiac Surgery and Cardiology, Bristol Royal Hospital for Children, Bristol, UK.,Departments of Cardiac Surgery and Cardiology, Bristol Heart Institute, Bristol, UK
| | - Serban Constantin Stoica
- Departments of Cardiac Surgery and Cardiology, Bristol Royal Hospital for Children, Bristol, UK.,Departments of Cardiac Surgery and Cardiology, Bristol Heart Institute, Bristol, UK
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