Page 48 - BH-2-3

Brain & Heart Balloon valvuloplasty for aortic stenosis

2.1. BAV technique 23 children with AVS. The peak aortic valve pressure

Most commonly, a retrograde arterial approach using one gradient was reduced from 113 ± 48 to 32 ± 15 mmHg
balloon is utilized for BAV (Figures 1 and 2); the balloon- (p < 0.001) after BAV. Mild aortic regurgitation developed
annulus (BA) ratio is set between 0.8 and 1.0. If the aortic
valve annulus is too large for one balloon, a dual balloon A B
method (Figures 3 and 4) may be used. If a two-balloon
method is utilized, the combined balloon diameter may be
estimated by equation I 13,14 :

Combined balloon diameter = 0.82 (D + D ) (I)
1 2
Since there is a potential for femoral artery occlusion in
newborns and infants, different routes of approach, such as
umbilical artery and umbilical vein (Figures 5 and 6),
15
16
have been utilized for BAV. Other approaches, such as
subscapular, axillary, and carotid artery, have also been
advocated by some interventionalists; however, these
routes of access are not popular. Figure 3. Diagrams illustrating the position of two balloon valvuloplasty
catheters through the aortic valve in a patient in lateral projections.
3. Immediate results Waisting of the balloons is seen in frame A (arrows), which is totally
eliminated after additional balloon inflation (B). The aorta (Ao) and left
Lababidi was the earliest investigator to publish ventricle (LV) are labeled. Replicated from Rao. 10
8
immediate outcomes of BAV; he reported the results of
A B
A B

Figure 1. Diagrams illustrating the location of the balloon valvuloplasty Figure 4. Diagrams illustrating the position of two balloon valvuloplasty
catheter through the aortic valve in a neonate in anteroposterior catheters through the aortic valve in a child in right anterior oblique
projections. Waisting of the balloon is seen in frame A (arrow), which is projections. Waisting of the balloons is seen in frame A (arrows), which is
completely abolished (arrow in B) on the additional filling of the balloon. totally eliminated after additional balloon inflation (B). Aorta (Ao), guide
The ascending aorta (Ao), descending aorta (DAo), guide wire (GW), left wires (GWs), and left ventricle (LV) are labeled. Reproduced from Agu
ventricle (LV), and marker catheter (MC) are shown. Reproduced from and Rao. 12
Agu and Rao. 12
A B
A B

Figure 5. Diagrams illustrating the location of the balloon valvuloplasty
catheter through the aortic valve in a neonate in anteroposterior
Figure 2. Diagrams illustrating the location of the balloon valvuloplasty projections. Waisting of the balloon is seen in frame A (arrow) which
catheter through the aortic valve in a child in lateral projections. Waisting is completely abolished (arrow in B) on the additional balloon inflation.
of the balloon is seen in the frame a (arrow-heads), which is completely The ascending aorta (Ao), left atrium (LA), left ventricle (LV), and right
abolished (arrow-heads in b) on additional inflation of the balloon. atrium (RA) are shown. Reproduced from Rao. 17

Volume 2 Issue 3 (2024) 2 doi: 10.36922/bh.2914