This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McElhinney, D. B. Articles by Colan, S. D. Search for Related Content PubMed PubMed Citation Articles by McElhinney, D. B. Articles by Colan, S. D. Related Collections Valvular heart disease Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2005;111:451-458.)
© 2005 American Heart Association, Inc.

Valvular Heart Disease

Left Heart Growth, Function, and Reintervention After Balloon Aortic Valvuloplasty for Neonatal Aortic Stenosis

Doff B. McElhinney, MD; James E. Lock, MD; John F. Keane, MD; Adrian M. Moran, MD; Steven D. Colan, MD

From the Department of Cardiology, Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass.

Correspondence to Steven D. Colan, MD, Department of Cardiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail steven.colan{at}cardio.chboston.org

Received June 15, 2004; revision received October 7, 2004; accepted October 25, 2004.

Background— Transcatheter balloon aortic valvuloplasty (BAVP) has become the first-line treatment for critical aortic stenosis (AS) in neonates. However, little is known about the growth and function of left heart structures or about patterns of reintervention on the left heart after neonatal BAVP.

Methods and Results— Between 1985 and 2002, 113 patients underwent neonatal BAVP at 60 days of age. There were 16 early deaths (14%), with a significant decrease from 1985 to 1993 (22%) to 1994 to 2002 (4%), and 6 patients had successful early conversion to a univentricular circulation. In the short term, the mean relative gradient reduction was 54±26%, and significant aortic regurgitation (AR) developed in 15% of patients. The 91 early survivors with a biventricular circulation were followed up for 6.3±5.3 years, during which time there was a steady increase in the frequency of significant AR. Freedom from moderate or severe AR was 65% at 5 years. In almost all patients with a baseline aortic annulus z score less than –1, the annulus diameter increased to within the normal range within 1 to 2 years. Similarly, left ventricular (LV) end-diastolic dimension z scores, which ranged from –5 to 7.5 before BAVP, normalized within 1 to 2 years in nearly all patients with a predilation z score less than –1. Among early survivors with a biventricular circulation, reintervention-free survival on the LV outflow tract was 65% at 1 year and 48% at 5 years, with younger age, higher pre- and post-BAVP gradients, and a larger balloon-annulus diameter ratio associated with decreased reintervention-free survival (P<0.01). Seventeen surgical interventions were performed on the aortic valve in 15 patients, including replacement in 7. Survival free from aortic valve replacement was 84% at 5 years.

Conclusions— BAVP for AS during the first 60 days of life results in short-term relief of AS in the majority of patients. Among early survivors, initially small left heart structures may be associated with worse subacute outcomes but typically normalize within 1 year. Reintervention for residual/recurrent AS or iatrogenic AR is relatively common, particularly during the first year after BAVP, but aortic valve replacement during early childhood is seldom necessary.

Key Words: aorta • stenosis • regurgitation • valvuloplasty

This article has been cited by other articles:

				D. W. Brown, E. C. Chong, K. Gauvreau, J. F. Keane, J. E. Lock, and A. C. Marshall Aortic Wall Injury as a Complication of Neonatal Aortic Valvuloplasty: Incidence and Risk Factors Circ Cardiovasc Interv, August 1, 2008; 1(1): 53 - 59. [Abstract] [Full Text] [PDF]

				S. Fratz, H. P. Gildein, G. Balling, W. Sebening, T. Genz, A. Eicken, and J. Hess 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, March 4, 2008; 117(9): 1201 - 1206. [Abstract] [Full Text] [PDF]

				E. A. Bacha Invited Commentary Ann. Thorac. Surg., March 1, 2008; 85(3): 808 - 809. [Full Text] [PDF]

				R. K. Han, R. C. Gurofsky, K.-J. Lee, A. I. Dipchand, W. G. Williams, J. F. Smallhorn, and B. W. McCrindle Outcome and Growth Potential of Left Heart Structures After Neonatal Intervention for Aortic Valve Stenosis J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2406 - 2414. [Abstract] [Full Text] [PDF]

				V. Hraska, J. Photiadis, and C. Arenz Open valvotomy for aortic valve stenosis in newborns and infants MMCTS, June 19, 2007; 2007(0619): 2311. [Abstract] [Full Text] [PDF]

				B. Alsoufi, T. Karamlou, B. W. McCrindle, and C. A. Caldarone Management options in neonates and infants with critical left ventricular outflow tract obstruction Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1013 - 1021. [Abstract] [Full Text] [PDF]

				M. Nathan, D. Rimmer, P. J. del Nido, J. E. Mayer, E. A. Bacha, A. Shin, W. Regan, R. Gonzalez, and F. Pigula Aortic Atresia or Severe Left Ventricular Outflow Tract Obstruction with Ventricular Septal Defect: Results of Primary Biventricular Repair in Neonates Ann. Thorac. Surg., December 1, 2006; 82(6): 2227 - 2232. [Abstract] [Full Text] [PDF]

				S. D. Colan, D. B. McElhinney, E. C. Crawford, J. F. Keane, and J. E. Lock Validation and Re-Evaluation of a Discriminant Model Predicting Anatomic Suitability for Biventricular Repair in Neonates With Aortic Stenosis J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1858 - 1865. [Abstract] [Full Text] [PDF]