MANAGEMENT OF PEDIATRIC-PATIENTS WITH ISOLATED VALVAR AORTIC-STENOSISBY BALLOON AORTIC VALVULOPLASTY

Moderate to severe aortic stenosis in children requires an initial pro cedure to improve the stenosis and often additional procedures for rec urrent stenosis or aortic insufficiency before adulthood. The purpose of this study was to evaluate children who underwent balloon valvulopl asty and were followed with a specific management plan, Twenty-two chi ldren with aortic stenosis underwent balloon valvuloplasty and were fo llowed on a regular basis, Repeat valvuloplasty was performed if indic ated, The initial gradient was reduced from 63 +/- 9 mmHg to 28 +/- 8 mmHg (P < 0.001), There were no deaths and only one major complication , which had no sequelae. Average follow-up was 61 +/- 23 months. Three patients required valve replacement 39-76 months after valvuloplasty for progressive insufficiency, Seven patients underwent successful rep eat valvuloplasty, The overall probability of survival without surgica l intervention was 75% at 100 months, Balloon valvuloplasty is an effe ctive intermediate palliation for aortic stenosis and is an acceptable alternative to surgical valvotomy. Repeat valvuloplasty is successful without additional risk. In a subgroup of patients, aortic insufficie ncy is progressive and will require surgical intervention. (C) 1996 Wi ley-Liss, Inc.