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Criteria for selection of balloon valvoplasty for treatment of aortic stenosis in neonates

Published online by Cambridge University Press:  19 August 2008

Andrea Donti ,
Marco Bonvicini ,
Gaetano Gargiulo ,
Guido Frascaroli  and
Fernando M. Picchio
Andrea Donti*
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Marco Bonvicini
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Gaetano Gargiulo
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Guido Frascaroli
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
Fernando M. Picchio
Affiliation:
From the Section of Pediatric Cardiology, Institute of Cardiovascular Disease, Department of Cardiac Surgery, Institute of Anesthesiology, University of Bologna, Bologna
*
Dr. Andrea Donti, Istituto di Malattie Cardiovascolari, Universita' degli Studi di Bologna, Via Massarenti N°9, Policlinico S. Orsola, 40138 Bologna, Italy. Fax. 39 51 344859
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Summary

In 10 neonates with critical aortic stenosis who were treated with balloon dilation, we investigated retrospectively the predictive value for mortality of three echocardiographic parameters: early diastolic mitral valvar diameter, left ventricular end-diastolic diameter, and diameter of the aortic root. Valvoplasty was technically successful in each patient and the peak systolic ejection gradient decreased from 85±42 to 22±13 mm Hg, but clinical success was achieved in only six neonates, with four dying. The diameter of the aortic root was similar in survivors and non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The association of a mitral valvar diameter equal to, or less than, 9 mm with a left ventricular end-diastolic diameter equal to, or less than, 14 mm identified clearly all those who did not survive. In the future, we will recommend patients with these anatomical features for primary Norwood palliation. Neonates with a mitral valvar diameter equal to or greater than 12 mm and a left ventricular end-diastolic diameter equal to or greater than 17 mm, in contrast, are good candidates for balloon dilation. All our patients with these anatomical features survived and are doing well at follow-up (30±14.8 months). Simple echocardiographic measurements, therefore, can help in predicting outcome and choosing the best treatment in neonates with critical aortic stenosis.

Keywords

Congenital aortic valvar stenosisneonatesaortic balloon dilationechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 1 , January 1995 , pp. 31 - 35
Copyright
Copyright © Cambridge University Press 1995

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