TRANSVASCULAR BALLOON DILATION FOR NEONATAL CRITICAL AORTIC-STENOSIS - EARLY AND MIDTERM RESULTS

Objectives. We evaluated our immediate and midterm (mean 4.3 years) re sults of balloon dilation of critical valvular aortic stenosis in 33 n eonates. Background. Balloon dilation has been used as an alternative to surgical treatment, Reports to date consist of small series (larges t 16 babies) with short-term follow up (longest 4.8 years). Methods. F rom 1985 to 1991, 33 neonates had dilation at a mean age of 13 days an d a mean weight of 3.4 kg, Nineteen of the neonates (58%) were intubat ed and received prostaglandins, and 94% had other cardiac abnormalitie s. Results. The dilation was completed retrograde in 31 of the neonate s (umbilical artery in 11 and femoral artery in 20) and anterograde (f emoral vein) in 2, The average immediate peak gradient and left ventri cular 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% an d 64%, respectively, At mean 4.3 years of follow-up, 83% of the surviv ors were asymptomatic; Doppler study revealed a maximal instantaneous gradient <50 mm Hg in 65% of neonates and significant aortic regurgita tion 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%). (C) 1997 by the American College of Cardiology.