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Brain & Heart Balloon valvuloplasty for aortic stenosis

in 10 of these children, and two patients required and left ventricular (LV) systolic and end-diastolic
surgical intervention. We evaluated the immediate pressures was demonstrated following BAV; the cardiac
outcomes of BAV in the late 1980s. Subsequently, index did not change. 18-20 A 60% drop in the aortic valve
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immediate outcomes for a higher number of patients pressure gradient was observed (Figure 10). The extent
were investigated. Results of BAV for calcific AVS in of aortic insufficiency (AI) did not worsen (Figure 11),
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the elderly are not included in this paper. Reduction and none of the patients had grade 3+ AI. In fact, AI
in peak aortic valve pressure gradients (Figures 7-9) improved in some children, which was thought to be
due to better coaptation of the aortic valve leaflets after
BAV. Echocardiographic studies showed no change in
the end-diastolic LV dimension, the LV posterior wall
measurement in diastole, and the contractile function of
the LV following BAV (Figure 12). Except for neonates,
almost all children were discharged the day after the
procedure. The immediate outcomes of BAV documented
by other cardiologists 21-35 during the 5-year period
(1983 – 1988) following the initial description of BAV
are similar to the author’s observations. 18,19 More recent
studies of BAV reported between 2019 and 2023 36-62 also
show outcomes similar to those described above.
4. Intermediate-term results

Intermediate-term results, defined as 6 months to
2 years after BAV, have been evaluated by several
Figure 6. Diagram illustrating the course of the balloon valvuloplasty 8
catheter (BALL CATH) across the aortic valve in a neonate in authors. Short-term data reported by Lababidi et al.,
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10
anteroposterior projections. The ascending aorta (AAo), descending Walls et al., and others, as summarized elsewhere,
aorta (DAo), endotracheal tube (ET), left atrium (LA), left ventricle (LV), demonstrate sustained relief of aortic valve obstruction
a nasogastric tube (NG), right atrium (RA), and umbilical venous (UV) with residual aortic valve gradients in the high 30s to
are shown. Reproduced from Agu and Rao. 12 low 40s mmHg. 6,10,21 In the author’s study subjects, 10,18,19
the peak-to-peak aortic valve systolic pressure gradients
A B remained lower than pre-BAV aortic valve gradients
(Figures 9 and 13). The decline in the pressure gradients
was evident through both cardiac catheterization
(Figure 9) and Doppler studies (Figure 13). 10,18,19 The
end-diastolic diameter of the LV, posterior wall thickness
of the LV in diastole, and the LV shortening fraction did
not significantly alter (p > 0.1) at short-term follow-up.
The magnitude of AI also remained unchanged in the
short term. Nonetheless, when assessing the outcomes
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C of each child, recurrence of AVS (aortic valve peak
gradient >50 mmHg) was observed in 23% of patients
(Figure 14). During the author’s early experience
with BAV, four patients had surgical valvotomy, and
subsequently, two children had a second BAV; these
interventions were undertaken 9 months (median)
following the first BAV. Short-term results documented
by other researchers 36,38-40,42,48,51,52,53,55,57 were similar to the
author’s previous work.
Figure 7. Pressure recordings from the aorta (Ao) (A) and left ventricle Causes of restenosis were investigated by examining
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(LV) (B) before balloon aortic valvuloplasty (BAV) indicated a significant
aortic valve gradient. Following BAV (C), the aortic valve pressure differences between the good and poor results groups
gradient is remarkably reduced. Reproduced from Rao. 10 (Figure 15). The factors associated with poor outcomes

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