Çocuklarda Aortik Balon Valvüloplasti Uygulaması

Abstract

Advances in pediatric cardiology in the past 30 years, allowed transcatheter treatment of valvular aortic stenosis, as well as many other diseases. The aim of this study is to investigate the characteristics; procedure findings and long term follow up results of patients who had undergone aortic valvuloplasty between 2000 and 2012 in Hacettepe University Ihsan Dogramaci Children’s Hospital, Department of Pediatric Cardiology. The hospital records of patients were retrospectively evaluated. One-hundred and thirty balloon valvuloplasty procedures were performed to a total of 120 patients, with an age range between 1 day and 18 years; and body weight range of 1.-80 kilograms. The hemodynamic studies at the catheter laboratory revealed that the mean left ventricle pressure before the procedure declined from mean 162 ± 32 mmHg (72-276; median:160 mmHg) to a mean 126 ± 34 mmHg (64-254; median: 120 mmHg) after the procedure. The systolic gradient of the aortic valve decreased from mean 69.7 ± 23 mmHg (7-145; median: 69.5 mmHg) before the procedure to a mean 27.4 ± 21 mmHg (0-149; median: 25 mmHg) after. Third grade aortic insufficiency was found in 18 procedures (13%) during control injections after the procedure. Fast pacing method for valvuloplasty was performed in 56 patients. Balloon valvuloplasty failed in two patients (3.6%) who had the procedure with a fast pacing; only 2 patients developed third grade aortic insufficiency. Among the patients who valvüloplasty performed by standard method, balloon valvuloplasty failed in 6 patients (8.3%), whereas third grade aortic insufficiency was seen in 15 (20.2%). Fast pacing balloon valvuloplasty decreased the incidence of post-procedure severe aortic insufficiency significantly (p<0.01) but it had no effect on the success rate of the procedure. Fast pacing did not change the procedure duration, but decreased the flouroscopy duration significantly (p<0.01). Twenty six surgical procedures were performed after ballon valvuloplasty; the indications were v valvular aortic stenosis in 17 patients (15%); coarctation of the aorta in 3 patients and subaortic membrane resection and valvular aortic stenosis in 2 patients. Long term follow up results of the patients revelead that the peak gradient which was calculated as 28 ± 19.2 mmHg with echocardiographic continuous doppler measurements one day after the procedure, became 37.48 ± 20.5 mmHg, which was not statistically different. The degree of aortic insufficiency did not change significantly in time, but 6 patients required aortic valve replacement. Eight patients (6.6%) died; only one of these patients died due to cardiovascular arrest during the procedure. In conclusion, balloon valvuloplasty is a safe, palliative treatment of valvular aortic stenosis. It should be preferred in newborns with valvular aortic stenosis who are not hemodynamically stable. Fast pacing can be used safely in all age groups; it decreases failure rate, eases the procedure and prevents the development of aortic insufficiency with stabilization of the balloon.