PERCUTANEOUS AORTIC VALVULOPLASTY IN CHIL DREN - NONINVASIVE EVALUATION AND CRITERIA OF SUCCESS

The results of percutaneous aortic valvuloplasty in 15 children (avera ge 8.4 years) were evaluated by echocardiography and non-invasive crit eria of the indication for this procedure were defined The aortic valv e was unthickened in 7 patients (Group I) and dystrophic in the other 8 (Group II). Valvuloplasty decreased the transvalvular pressure gradi ent by 47 +/- 33 %. Aortic regurgitation was aggravated in 4 patients. The reduction in pressure gradient was significantly greater in Group I than in Group II (64 +/- 19 % vs 31 +/- 35 %, p < 0.05). In Group I , in contrast to Group II, the results remained stable after an averag e follow-up of 14.5 months. When the maximal instantaneous pressure gr adient on Doppler examination was < 80 mmHg, the peak-to-peak gradient at catheterisation was on average 21 % less, whereas when the Doppler gradient was 80 mmHg or more, the percentage difference was only 8 %. The myocardial mass index was over the 95th percentile in 7/8 patient s with gradients > 80 mmHg whilst it was only increased in 1 patient w ith a gradient < 80 mmHg. Elecuocardiographic LVH was observed in 6 of the 8 patients with a gradient > 80 mmHg but in none of the others. A lthough valvuloplasty reduced the transvalvular pressure gradient, the results were much less satisfactory in the dystrophic valves. The fol lowing indications were proposed for this techniques : a Doppler maxim al pressure gradient greater-than-or-equal-to 80 mmHg, associated with at least one criterion of left ventricular hypertrophy.