RELEVANCE OF THE CLINICAL AND ECHOCARDIOG RAPHIC DATA IN NEONATAL BALLOON AORTIC VALVULOPLASTY

Objectives. The selection of patients for balloon aortic valvuloplasty is a vital clinical challenge in neonatal aortic stenosis. The presen t study was designed to establish possible predicting factors for poor results after balloon therapy. Patients and methods. 2D echocardiogra phic, Doppler color and clinical variables (grade of cardiac failure, aortic << anulus >>, mitral anulus, left ventricular diameter, ascendi ng aorta, instantaneous Doppler gradient, and grade of aortic regurgit ation) were analyzed in 32 neonates submitted to balloon dilation at 2 2 +/- 18 days oflife. The evaluations were conducted during three peri ods in respect to balloon theraphy CA: before; B: immediately after, a nd C: mid-term follow-np). The outcome in both, B and C periods was de fined as favorable Call survivors with Doppler gradient less than or e qual to 70 mmHg and noother intervention on the valve) and unfavorable (death, first stage of univentricularization, valvular replacement or survivors with Doppler gradient > 70 mmHg). Mean values between subgr oups were compared by Wilcoxon test; unconditional logistic regression was used to analyze the impact of cardiac failure and anatomic variab les (continuous, categorized or Z) on the outcome. Results. The Dopple r gradient decreased from 70 +/- 28 to 34 +/- 14 mmHg after the valvul oplasty, and no changes were detected in the follow-up period (36 +/- 8 mmHg). An immediate favorable result was obtained in 72% of the pati ents; its consisted of 50% in period C. Nine neonates had an immediate unfavorable outcome (6 deaths and 3 with Norwood operation). In the f ollow-up, three patients had valvular replacement, one patient Doppler gradient > 70 mmHg and one patient with left ventricular endomyocardi al abnormalities died. The severe cardiac failure (odds ratio: 33; CL 2.4-443; p = 0.008) and all categorized anatomic variables (aortic << anulus >> less than or equal to 6 mm; mitral anulus less than or equal to 9 mm; ascending aorta less than or equal to 8 mm; left ventricular diameter less than or equal to 13 mm) were related with the immediate poor outcome. At 7.6 years, survival and freedom with no valvular rep lacement nor reintervention probability rates were 83% and 67%, respec tively. Conclusions. 2D echo Doppler provides essential information ab out the anatomic and functional lesions coexisting with severe or crit ical aortic stenosis in neonates. Patients with left heart hypoplasia and severe heart failure should not be candidates for balloon valvulop lasty. The degree of residual aortic regurgitation and endomyocardial abnormalities of the left ventricle play an important role in the mid- term follow-up.