CRITICAL NEONATAL AORTIC VALVE STENOSIS, INTERMEDIATE AND IMMEDIATE RESULTS OF PERCUTANEOUS BALLOON VALVULOPLASTY

Aim: To evaluate immediate and midterm results after balloon valvuloplasty in an infant population with critical aortic stenosis, giving special consideration to relief of aortic stenosis, degree of aortic regurgitation (AR), left ventricular function, and duration of freedom from reintervention. Method: It was a retrospective follow-up study held in the Pediatric Cardiac Surgery department of Bahawal Victoria Hospital, Bahawalpur for two-years duration from November 2018 to November 2020. A retrospective control study was performed on 25 newborns, in whom balloon aortic dilation was performed. We assessed clinical and echocardiographic outcomes for the degree of restenosis, LV function, AR, and the need for re-intervention. Result: The median age at enlargement was 45 days (range 6 days to 120 days). The median body weight was 3.9 kg (1.9 kg-6.4 kg). Balloon valvuloplasty was performed with manual balloon inflation through the femoral artery. The mean aortic systolic pressure gradient decreased from 70 ± 7.23 mmHg to 40 mmHg ± 4.3 (p = 0.001). Mild aortic regurgitation occurred in 12 patients, while one patient had perforation of a non-coronary nodule leading to severe AR requiring surgery. There was one death during the procedure. There was no AR progression in the mean follow-up of 25 months (3.0 - 24 months). No patient required re-intervention for restenosis. LV function improved in 9 of 11 patients (82%), while 2 months after surgery there was one death due to persistent LV dysfunction. Conclusion: Balloon valvuloplasty in infants with critical AS is a safe and effective therapeutic procedure. Mortality is 8%. Mild aortic regurgitation does not progress in the short to medium term. There is no restenosis in the intermediate period, and LV function improves in most patients. Keywords: aortic stenosis, balloon valvuloplasty, left ventricular (LV) dysfunction, interventional procedures, aortic regurgitatio