Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm results

Department of Cardiology, Children's Hospital, Boston, Massachusetts, USA.

OBJECTIVES: We evaluated our immediate and midterm (mean 4.3 years) results of balloon dilation of critical valvular aortic stenosis in 33 neonates. BACKGROUND: Balloon dilation has been used as an alternative to surgical treatment. Reports to date consist of small series (largest 16 babies) with short-term follow-up (longest 4.8 years). METHODS: From 1985 to 1991, 33 neonates had dilation at a mean age of 13 days and a mean weight of 3.4 kg. Nineteen of the neonates (58%) were intubated and received prostaglandins, and 94% had other cardiac abnormalities. RESULTS: The dilation was completed retrograde in 31 of the neonates (umbilical artery in 11 and femoral artery in 20) and anterograde (femoral vein) in 2. The average immediate peak gradient and left ventricular end-diastolic pressure reductions were 54% and 20%, respectively. The overall mortality rate was 12% (three early deaths and one late). All 20 neonates dilated through a femoral artery initially had pulse loss with restoration in 35% after thrombolytic therapy. At 8.3 years, survival and freedom of reintervention probability rates were 88% and 64%, respectively. At mean 4.3 years of follow-up, 83% of the survivors were asymptomatic; Doppler study revealed a maximal instantaneous gradient < 50 mm Hg in 65% of neonates and significant aortic regurgitation in 14%. CONCLUSIONS: This study confirms that dilation of aortic stenosis in neonates is effective; reintervention (mostly redilation) is frequent (40%); and midterm survival is encouraging (88%).

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