EFFECTIVENESS OF BALLOON VALVULOPLASTY IN THE YOUNG-ADULT WITH CONGENITAL AORTIC-STENOSIS

The objective of this study was to assess the effectiveness of balloon valvuloplasty in the young adult with congenital aortic stenosis and to compare its effectiveness with children, Percutaneous balloon valvu loplasty is effective in children with congenital aortic stenosis, but not in adults with acquired calcific aortic stenosis, Because effecti veness of balloon valvuloplasty in young adults with congenital aortic stenosis is not well defined, we evaluated the outcome in 15 patients aged 16-24 years (18 +/- 0.6; mean +/- SEM) who underwent balloon val vuloplasty from 1985 to 1993. The aortic valve annulus diameter ranged from 18.5 to 30 mm (24 +/- 0.9). The aortic valve was bicuspid in 12 and tricuspid in 3 patients, and calcification was present in one pati ent, Balloon valvuloplasty was performed using a double balloon techni que in 12 patients and a single balloon technique in three patients, T hree patients had inadequate relief of gradient with a residual peak s ystolic gradient greater than or equal to 70 mm Hg, Three patients req uired valve replacement-two patients for a residual gradient greater t han or equal to 70 mg Hg, and one patient 4 years later for severe aor tic valve regurgitation, Eight of the remaining 12 have undergone elec tive follow-up catheterization 1.2-2.5 years (1.5 +/- 0.1) later. The peak systolic aortic valve gradient decreased by 55% from 73 +/- 5.8 m m Hg to 35 +/- 5.4 mm Hg immediately postvalvuloplasty, and was 30 +/- 4.4 mm Hg at follow-up (P < 0.001). The left ventricular systolic pre ssure decreased from 179 +/- 7.5 to 147 +/- 6.5 mm Hg immediately post valvuloplasty and was 147 +/- 4 mm Hg at follow-up, Aortic insufficien cy was unchanged after valvuloplasty in 9, increased by 1 + in 4, and by 2 + in 2 patients, Balloon valvuloplasty was as effective in these young adults as in 70 children (age 6 +/- 0.7 years) with congenital a ortic stenosis (peak systolic gradient pre- 79 +/- 3 mm Hg versus post - 34 +/- 2 mg Hg; at 1-2 years follow-up 34 +/- 4 mm Hg). Balloon valv uloplasty provides effective treatment in most young adults with conge nital aortic stenosis, without early restenosis, Balloon valvuloplasty is as effective in young adults as in children, where it is currently the treatment of choice. (C) 1995 Wiley-Liss, Inc.