Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy.

Abstract

Balloon aortic valvotomy (BAV) is an alternative to surgical valvotomy is infants and children. We compared BAV in 16 consecutive neonates (1985-1988) to surgical valvotomy in a prior group of 16 consecutive neonates (1978-1984). Both groups were comparable in terms of age, weight, hemodynamic data, left ventricular size, and associated lesions. There were six early and one late deaths after surgery. Five out of six neonates requiring a second operation died. Left ventricular size (measured in 13 neonates) had some influence on survival after surgery: three of three with small or hypoplastic left ventricles and three of 10 with normal-sized left ventricular died. After BAV, there were three early deaths, two patients who underwent stage I palliation of hypoplastic left heart syndrome, and two late deaths. As with surgical valvotomy, left ventricular size seemed to influence survival after BAV: five of six with small or hypoplastic left venticles died or underwent stage I palliation for hypoplastic left heart syndrome and two of nine with normal-sized left ventricles died. At follow-up (26.+-.17 months) in six patients in the surgical group, the peak systolic ejection gradient (PSEG) was 52.2.+-.23 mm Hg and left ventricular end-diastolic presure (LVEDP) 18.2.+-.5.2 mm Hg. Aortic regurgitation was mild in five and moderate in the sixth patient. At follow-up (17.6.+-.7.8 months) in nine patients in the balloon dilation group, the PSEG was 45.6.+-.11 mm Hg in five patients at catheterization and 43.8.+-.22.9 mm Hg in four patients by echocardiography-Doppler. Aortic regurgitation was mild in three and absent in the other six patients. BAV may be an effective alternative to surgical valvotomy in unselected neonates with critical valvar aortic stenosis.