BALLOON DILATATION OF THE AORTIC-VALVE AFTER PREVIOUS SURGICAL VALVOTOMY - IMMEDIATE AND FOLLOW-UP RESULTS

Objective-To evaluate the immediate and long-term results of transcath eter balloon dilatation of the aortic valve for restenosis after previ ous surgical valvotomy. Design-Prospective follow up by clinical exami nation and cross sectional Doppler echocardiography of all patients fu lfilling the above criteria. Setting-Tertiary paediatric cardiology re ferral centre. Patients and methods-22 patients (18 4 female)-median ( range) age (12-254) months-underwent 25 balloon dilatation procedures at a median of 72 (8-155) months after surgery. The median age at surg ical valvotomy was 82.5 (0.5-230) months and the systolic gradient acr oss the aortic valve immediately after surgery was 31 (0-49) mm Hg. Th e indication for dilatation was a Doppler derived peak instantaneous g radient of > 60 mm Hg with grade 2 or less aortic regurgitation. A sin gle balloon was used, and the median balloon to annulus ratio was 1 (0 .9-1). Results-After dilatation the catheter pullback gradient decreas ed acutely from 55 (35-75) to 30 (0-75) mm Hg (p < 0.01) and the Doppl er gradient from 74 (52-92) to 40.5 (30-96) mm Hg (p < 0.01). In three patients who underwent a second dilatation of the aortic valve eight months after the first procedure, the pullback gradient decreased from 50 (50-60) to 15 (15-16) mm Hg. Aortic regurgitation grade increased from 1 (0-2) to 2 (1-3); only one patient had grade 3 regurgitation. O ver a median follow up of 33 (2-67) months seven patients had aortic v alve replacement for recurrent stenosis (six patients) or severe regur gitation (one patient with grade 3 regurgitation after dilatation, who had partial detachment of one of the valve leaflets). There was no si gnificant difference for the pullback gradient (median of 19 v 32.5 mm Hg), Doppler gradient 24 hours after dilatation (33.5 v 50.5 mm Hg; p = 0.03), or the duration of follow up (27.5 y 18 months) between the 12 patients who did not require further dilatation or surgery and the 10 patients who did. Conclusions-Balloon dilatation of the aortic valv e is a safe and feasible option for palliation of restenosis after sur gical valvotomy for congenital aortic valve stenosis. In many patients , however, stenosis progressed and a further intervention was required .