Midterm outcome of percutaneous balloon aortic valvuloplasty guided by single echocardiography for congenital aortic stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Yongquan , ZHAO Guangzhi , LI Muzi , GONG Dingxu , ZHANG Fengwen , OUYANG Wenbin ,  PAN Xiangbin

Structual Heart Disease Center, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, P.R.China;

Corresponding author：

PAN Xiangbin, Email: xiangbin428@hotmail.com

Keywords：

Percutaneous balloon aortic valvuloplasty; congenital aortic stenosis; echocardiography

DOI：

10.7507/1007-4848.201805060

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the midterm outcome of patients with congenital aortic stenosis undergoing percutaneous balloon aortic valvuloplasty (PBAV) by single echocardiographic guidance. Methods The clinical data of 12 patients with congenital aortic stenosis who underwent PBAV by single echocardiographic guidance at Fuwai Hospital from January 2016 to November 2017 were retrospectively analyzed. There were 7 males and 5 females with an average age of 18.27±15.30 years. The preoperative peak pressure gradient was 61.8–110.0 (80.30±24.50) mm Hg, and 50% of patients had aortic regurgitation. Results All patients successfully underwent PBAV. Aortic annulus diameter was 18.65±3.17 mm and balloon diameter was 17.62±3.77 mm, with balloon diameter to annulus diameter ratio of 0.92±0.07. The peak transaortic gradient was 16-51 (36.72±12.33) mm Hg immediately after procedure, which was significantly different from the preoperation (P=0.000). During the follow-up period, the peak transaortic gradient was 21-58 (37.06±13.52) mm Hg, and there was no significant difference between the follow-up and immediate postoperation (P=0.310). Immediately after procedure and during follow-up, 58% of patients had aortic regurgitation, which was not statistically different from the preoperation (P=0.682). Conclusion Systematic use of Doppler echocardiographic guidance for PBAV is feasible, and that it is associated with a high success rate and a very low complication rate.

Citation： XIE Yongquan, ZHAO Guangzhi, LI Muzi, GONG Dingxu, ZHANG Fengwen, OUYANG Wenbin, PAN Xiangbin. Midterm outcome of percutaneous balloon aortic valvuloplasty guided by single echocardiography for congenital aortic stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 829-833. doi: 10.7507/1007-4848.201805060 Copy

1.	Lababidi Z. Aortic balloon valvuloplasty. Am Heart J, 1983, 106(4 Pt 1): 751-752.
2.	Cribier A, Savin T, Saoudi N, et al. Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement? Lancet, 1986, 1(8472): 63-67.
3.	张瑞岩. 主动脉瓣狭窄程度的判定及治疗推荐——2014美国心脏病学会/美国心脏病学会瓣膜病指南解读. 中国医刊, 2015, 50(1): 23-25.
4.	中国医师协会儿科医师分会先天性心脏病专家委员会. 儿童常见先天性心脏病介入治疗专家共识. 中华儿科杂志, 2015, 53(1): 17-24.
5.	Moore P, Egito E, Mowrey H, et al. Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol, 1996, 27(5): 1257-1263.
6.	Weber HS, Mart CR, Kupferschmid J, et al. Transcarotid balloon valvuloplasty with continuous transesophageal echocardiographic guidance for neonatal critical aortic valve stenosis: an alternative to surgical palliation. Pediatr Cardiol, 1998, 19(3): 212-217.
7.	Patel S, Saini AP, Nair A, et al. Transcarotid balloon valvuloplasty in neonates and small infants with critical aortic valve stenosis utilizing continuous transesophageal echocardiographic guidance: A 22 year single center experience from the cath lab to the bedside. Catheter Cardiovasc Interv, 2015, 86(5): 821-827.
8.	Bourgault C, Rodés-Cabau J, Côté JM, et al. Usefulness of Doppler echocardiography guidance during balloon aortic valvuloplasty for the treatment of congenital aortic stenosis. Int J Cardiol, 2008, 128(1): 30-37.
9.	Bacher K, Bogaert E, Lapere R, et al. Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation, 2005, 111(1): 83-89.
10.	Cohen S, Liu A, Gurvitz M, et al. Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease. Circulation, 2018, 137(13): 1334-1345.
11.	Baysson H, Réhel JL, Boudjemline Y, et al. Risk of cancer associated with cardiac catheterization procedures during childhood: a cohort study in France. BMC Public Health, 2013, 13: 266.
12.	Meinel FG, Nance JW Jr, Harris BS, et al. Radiation risks from cardiovascular imaging tests. Circulation, 2014, 130(5): 442-445.
13.	Andreassi MG, Ait-Ali L, Botto N, et al. Cardiac catheterization and long-term chromosomal damage in children with congenital heart disease. Eur Heart J, 2006, 27(22): 2703-2708.
14.	Modan B, Keinan L, Blumstein T, et al. Cancer following cardiac catheterization in childhood. Int J Epidemiol, 2000, 29(3): 424-428.
15.	Pan X, Ouyang W, Li S, et al. Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance. Zhonghua Xin Xue Guan Bing Za Zhi, 2015, 43(1): 31-33.
16.	Liu Y, Guo GL, Ouyang WB, et al. Feasibility and effectiveness of percutaneous ventricular septal defect closure under solely guidance of echocardiography. Zhonghua Yi Xue Za Zhi, 2017, 97(16): 1222-1226.
17.	Pan XB, Ou-Yang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol, 2015, 28(4): 390-395.
18.	Wang SZ, Ou-Yang WB, Hu SS, et al. First-in-human percutaneous balloon pulmonary valvuloplasty under echocardiographic guidance only. Congenit Heart Dis, 2016, 11(6): 716-720.
19.	McCrindle BW. Independent predictors of immediate results of percutaneous balloon aortic valvotomy in children. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Am J Cardiol, 1996, 77(4): 286-293.
20.	Sholler GF, Keane JF, Perry SB, et al. Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome. Circulation, 1988, 78(2): 351-360.
21.	Balmer C, Beghetti M, Fasnacht M, et al. Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart, 2004, 90(1): 77-81.
22.	Reich O, Tax P, Marek J, et al. Long term results of percutaneous balloon valvuloplasty of congenital aortic stenosis: independent predictors of outcome. Heart, 2004, 90(1): 70-76.

1. Lababidi Z. Aortic balloon valvuloplasty. Am Heart J, 1983, 106(4 Pt 1): 751-752.
2. Cribier A, Savin T, Saoudi N, et al. Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement? Lancet, 1986, 1(8472): 63-67.
3. 张瑞岩. 主动脉瓣狭窄程度的判定及治疗推荐——2014美国心脏病学会/美国心脏病学会瓣膜病指南解读. 中国医刊, 2015, 50(1): 23-25.
4. 中国医师协会儿科医师分会先天性心脏病专家委员会. 儿童常见先天性心脏病介入治疗专家共识. 中华儿科杂志, 2015, 53(1): 17-24.
5. Moore P, Egito E, Mowrey H, et al. Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol, 1996, 27(5): 1257-1263.
6. Weber HS, Mart CR, Kupferschmid J, et al. Transcarotid balloon valvuloplasty with continuous transesophageal echocardiographic guidance for neonatal critical aortic valve stenosis: an alternative to surgical palliation. Pediatr Cardiol, 1998, 19(3): 212-217.
7. Patel S, Saini AP, Nair A, et al. Transcarotid balloon valvuloplasty in neonates and small infants with critical aortic valve stenosis utilizing continuous transesophageal echocardiographic guidance: A 22 year single center experience from the cath lab to the bedside. Catheter Cardiovasc Interv, 2015, 86(5): 821-827.
8. Bourgault C, Rodés-Cabau J, Côté JM, et al. Usefulness of Doppler echocardiography guidance during balloon aortic valvuloplasty for the treatment of congenital aortic stenosis. Int J Cardiol, 2008, 128(1): 30-37.
9. Bacher K, Bogaert E, Lapere R, et al. Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation, 2005, 111(1): 83-89.
10. Cohen S, Liu A, Gurvitz M, et al. Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease. Circulation, 2018, 137(13): 1334-1345.
11. Baysson H, Réhel JL, Boudjemline Y, et al. Risk of cancer associated with cardiac catheterization procedures during childhood: a cohort study in France. BMC Public Health, 2013, 13: 266.
12. Meinel FG, Nance JW Jr, Harris BS, et al. Radiation risks from cardiovascular imaging tests. Circulation, 2014, 130(5): 442-445.
13. Andreassi MG, Ait-Ali L, Botto N, et al. Cardiac catheterization and long-term chromosomal damage in children with congenital heart disease. Eur Heart J, 2006, 27(22): 2703-2708.
14. Modan B, Keinan L, Blumstein T, et al. Cancer following cardiac catheterization in childhood. Int J Epidemiol, 2000, 29(3): 424-428.
15. Pan X, Ouyang W, Li S, et al. Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance. Zhonghua Xin Xue Guan Bing Za Zhi, 2015, 43(1): 31-33.
16. Liu Y, Guo GL, Ouyang WB, et al. Feasibility and effectiveness of percutaneous ventricular septal defect closure under solely guidance of echocardiography. Zhonghua Yi Xue Za Zhi, 2017, 97(16): 1222-1226.
17. Pan XB, Ou-Yang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol, 2015, 28(4): 390-395.
18. Wang SZ, Ou-Yang WB, Hu SS, et al. First-in-human percutaneous balloon pulmonary valvuloplasty under echocardiographic guidance only. Congenit Heart Dis, 2016, 11(6): 716-720.
19. McCrindle BW. Independent predictors of immediate results of percutaneous balloon aortic valvotomy in children. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Am J Cardiol, 1996, 77(4): 286-293.
20. Sholler GF, Keane JF, Perry SB, et al. Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome. Circulation, 1988, 78(2): 351-360.
21. Balmer C, Beghetti M, Fasnacht M, et al. Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart, 2004, 90(1): 77-81.
22. Reich O, Tax P, Marek J, et al. Long term results of percutaneous balloon valvuloplasty of congenital aortic stenosis: independent predictors of outcome. Heart, 2004, 90(1): 70-76.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Midterm outcome of percutaneous balloon aortic valvuloplasty guided by single echocardiography for congenital aortic stenosis

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