Circulation, Vol 78, 351-360, Copyright © 1988 by American Heart Association
GF Sholler, JF Keane, SB Perry, SP Sanders and JE Lock
We evaluated dilation technique (n = 80) and aortic valve morphology by
two-dimensional echocardiography (n = 58) in patients with congenital
aortic valve stenosis to determine their influence on outcome. Patients'
age (9 +/- 9 years; range, 1 day-39 years) and a history of surgical
valvotomy did not influence outcome. The number of dilating balloons (one
vs. two) and balloon: annulus ratio based on the largest balloon used in
each case (97 +/- 12%; range, 71-133%) did not demonstrably influence the
percent reduction in valvar gradient. In contrast, with a balloon: annulus
ratio greater than 100%, the incidence (26%) of significant,
dilation-induced aortic regurgitation was higher than occurred when the
ratio was equal to or less than 100% (11%). Fifty bicommissural and eight
unicommissural valves were identified echocardiographically. Relief of
obstruction was associated with apparent commissural division in 24 of 32
patients with suitable postdilation studies. The sites of fusion and
stenosis relief did not influence percent reduction in valvar gradient.
Substantial increases in aortic regurgitation (greater than three of five
grades) occurred in three of eight unicommissural and one of 50
bicommissural valves. The presence of a thick valve was associated with a
slightly lower gradient reduction (53 +/- 12%) than thin and pliant valves
(63 +/- 24%) (p greater than 0.05). Unlike all other congenital lesions we
have studied, dilation technique and balloon size appeared to have a lesser
influence on percent reduction in valvar gradient in congenital aortic
stenosis, although balloon: annulus ratio influences the increase in aortic
regurgitation. Valve morphology appears to assist with predicting the
outcome of dilation.
ARTICLES
Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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