P421Doppler- echocardiographic parameters predictor of outcomes in critical aortic valve stenosis treated by balloon angioplasty.


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Abstract

Purposes: Balloon angioplasty is a safe and effective palliative method for the treatment critical aortic stenosis (CAS) while frequently resulting in aortic insuffiency. We aimed to determine if echocardiographics parameters could predict aortic balloon dilatation early and mid-term outcomes.Methods: Twenty-three consecutive newborns (18 males) with CAS underwent echocardiographic guided balloon angioplasty from 2003 to 2011. Median age and weight were 11 ± 9.7 days and 3.2 ±0.6 kg, respectively. Echocardiography assessment included aortic valve morphology, aortic valve diameter, ascending aorta dimension, left ventricular dysfunction and presence of aortic insuffiency. Patients were divided into 3 groups: patients with bicuspid aortic valve with right and left cusp (n= 4), with anterior and posterior cup (n=9) and patients with undetermined aortic valve (n=10).Results: There was no difference between the groups regarding presence of aortic insuffiency but dilatation of the ascending aorta was more frequently associated with bicuspid aortic valve and right and left cusp (p<0,001). Median aortic valve annulus diameter was 7 (4-14) mm. Doppler-echocardiography-guided BAV was successful in all cases with a median trans-aortic gradient decreasing from 57 (15-118) to 23 (0-40 mm Hg (p=0,003). Ventricular function improved from 45 (20-79) to 65 (29-80)% (p=0,003). There was no difference between the groups of patients. One patient experienced severe aortic regurgitation occurring after balloon angioplasty requiring early Ross intervention 2 months later. Four patients (17%) had moderate aortic insuffiency: one patient died one day later of severe heart failure and one patient required a Ross procedure 2 months later.Conclusions: The type of aortic valve does not predict neither the severity of aortic valve stenosis nor the result of balloon angioplasty. Right and left bicuspid valve is associated with early ascending aorta dilatation. Doppler-echocardiography-guided balloon dilatation is successful in the treatment of CAS independently of the morphology of the valve or the presence of aortic insuffiency.

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