Balloon aortic valvuloplasty in children - A multicenter study in Japan

A questionnaire was used to survey the experience of 8 Japanese institution s with percutaneous transluminal aortic valvuloplasty (PTAV) in children. A mong 99 procedures reported in 88 patients, sufficient data for analysis wa s obtained from 76 procedures in 72 patients. In those 76 procedures the pr essure gradient decreased significantly from 68 +/- 25 (20-140) to 33 +/- 2 2(0-100) mmHg (p<0.01), whereas aortic regurgitation (AR) increased at leas t one grade in 26 cases (34%). None of the parameters analyzed in this stud y were predictors of an increase in AR. The reduction in pressure gradient was judged as good in 44 of the 76 procedures (58%). A larger ring diameter , larger balloon diameter and larger ratio balloon diameter/the normal pred icted diameter of the aortic valve ring significantly contributed to an eff ective reduction of pressure gradient. Follow up data (mean interval, 4 yea rs) was available for 26 of 39 clinically effective procedures. AR progress ed at least 1 grade in 11 (42%), and the pressure gradient re-developed to more than 50 mmHg in 2 cases (8%). In Japan, PTAV has been accepted as a us eful procedure for valvular aortic stenosis in children, but progressive AR or re-development of the pressure gradient is not uncommon even after clin ically effective PTAV.