Author + information
- Received April 15, 1986
- Revision received October 28, 1986
- Accepted November 20, 1986
- Published online April 1, 1987.
- Hrodmar Helgason, MD*,1,
- John F. Keane, MD§,1,
- Kenneth E. Fellows, MD1,
- Thomas J. Kulik, MD1 and
- James E. Lock, MD, FACC1,2
- ↵§Address for reprints: John F. Keane, MD, Department of Cardiology, The Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
To evaluate the risks of and optimal method for valve dilation in aortic stenosis, balloons of different sizes were used to dilate the normal aortic root in 16 lambs and then stenotic valves in 15 children. In the lambs, inflated balloon to aortic anulus diameter ratios ranged from 0.9 to 1.5. These hearts were examined immediately after the procedure. Ratios of 0.9 to 1.1 did not produce significant damage to the left ventricular outflow tract, whereas those of 1.2 to 1.5 produced tears or hematomas, or both, of the aortic valve leaflets (n = 3), mitral valve leaflets (n = 4) and interventricular septum (n = 4).
The 15 patients, aged 10 days to 15 years, underwent 16 balloon aortic valvotomy procedures. The balloonaortic anulus ratio ranged from 0.67 to 1.1 (mean 0.90). The average pressure gradient decreased 69% and, overall, the peak systolic gradient decreased from 86 ± 21 to 28 ± 14 mm Hg (p < 0.01) and the aortic valve area increased from 0.44 ± 0.11 to 0.73 ± 0.22 cm2/m2(p < 0.01). Immediately after the procedure an increase in aortic regurgitation was noted in 8 (57%) of 14 patients, but was never >3+ and has been well tolerated. Other early complications encountered consisted of transient left bundle branch block in two patients, temporary femoral artery occlusion in three and femoral artery rupture requiring operative management in one infant.
Balloon valvotomy can reduce the transvalvular gradient in most patients with valvular aortic stenosis when a balloon less than 1.1 times the aortic root diameter is used. Although an increase in aortic regurgitation occurs in most, it appears well tolerated over short-term follow-up.
- Received April 15, 1986.
- Revision received October 28, 1986.
- Accepted November 20, 1986.
- American College of Cardiology Foundation