CRITICAL AORTIC-STENOSIS IN THE NEONATE - A COMPARISON OF BALLOON VALVULOPLASTY AND TRANSVENTRICULAR DILATION

The optimal treatment of critical aortic stenosis in the neonate and i nfant remains controversial. We compared transventricular dilation usi ng normothermic cardiopulmonary bypass and percutaneous balloon aortic valvuloplasty with respect to early and late survival, relief of aort ic stenosis, degree of aortic insufficiency, left ventricular function , and freedom from reintervention. Between July 1987 and July 1993, 30 neonates and infants underwent transventricular dilation or balloon a ortic valvuloplasty for critical aortic stenosis. The patients in the transventricular dilation group (n = 21) ranged in age from 1 to 59 da ys (mean age 18.0 days +/- 19.1 days) and the balloon aortic valvulopl asty group (n = 9) from 1 to 31 days (mean age 10.0 days +/- 9.0 days) . There were no significant differences in weight, body surface area, or aortic anulus diameter between the two groups (p = 1.0). Associated cardiovascular anomalies were more common in the transventricular dil ation group (48%) than in the balloon aortic valvuloplasty group (11%) . After intervention, the degree of residual aortic stenosis and insuf ficiency was equivalent in the two groups as assessed by postprocedura l Doppler echocardiography. Ejection fraction improved within both gro ups (transventricular dilation 39% +/- 20.2% versus 47% +/- 22.0%; bal loon aortic valvuloplasty 51% +/- 16.1% versus 62% +/- 8.4%), and ther e was no significant difference between groups. The left ventricular m ass/volume ratio increased within both groups (p < 0.05) but with no s ignificant difference between groups (transventricular dilation 1.4 +/ - 0.5 gm/ml versus 1.8 +/- 0.6 gm/ml; balloon aortic valvuloplasty 1.1 +/- 0.6 gm/ml versus 1.7 +/- 0.4 gm/ml). Early mortality in the trans ventricular dilation group was 9.5% and in the balloon aortic valvulop lasty group, 11.1%. There was one late death in the transventricular d ilation group. Four patients from the transventricular dilation group (19%) and two patients from the balloon aortic valvuloplasty group (22 %) required reintervention for further relief of aortic stenosis. We c onclude that both transventricular dilation and balloon aortic valvulo plasty provide adequate and equivalent relief of critical aortic steno sis. The treatment strategy adopted should depend on other factors, in cluding associated cardiovascular anomalies, vascular access, preopera tive condition, and the technical expertise available at each institut ion.