Short and midterm results of balloon valvuloplasty in the neonate with critical aortic stenosis

Introduction: Postnatal therapy of critical aortic stenosis aims to relief left ventricular outflow tract obstruction and to improve left ventricular function. Aim of our study is to follow up neonates with critical aortic stenosis in respect to long term results.

Method: Prospective follow up of 17 neonates with critical aortic stenosis, 13 were diagnosed prenatally, 3 had previous intrauterine balloon valvuloplasty.

Results: Balloon valvuloplasty (BVP) was performed in ll at the age of 1.4±3.6 days and a weight of 2.8±0.77kg. Left ventricular contractility was below 15% in 12 neonates. In 16/17 neonates, BVP could be performed successfully, and all neonates survived BVP and left ventricular function improved. In 5 children with either mitral valve stenosis or insufficient left ventricular function an univentricular approach had to be achieved. Immediately postnatally, conventional echocardiographic examinations of those children revealing univentricular repair did not differ significantly from those with biventricular approach. In long term follow up, 5 children died –2 due to pulmonary hypertensive crisis, 1 after Norwood-operation, 1 after Gießen procedure and 1 after compassionate care.

Results: BVP can be performed in critical ill children with low birthweight with good initial results. But even after successfully BVP, biventricular repair is not possible in all children. Risk factors are mitral stenosis and left ventricular diastolic dysfunction. In neonates, long term results in critical aortic stenosis are sometimes unpredictable–this has to be emphasized in prenatal counceling.

balloon valvuloplasty - critical aortic stenosis - outcome