A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant
Background: Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.
Methods: The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.
Results: The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.
Conclusions: In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.
Ewert P, Bertram H, Breuer J, et al. 2011. Balloon valvuloplasty in the treatment of congenital aortic valve stenosis - a retrospective multicenter survey of more than 1000 patients. Int J Cardiol 149(2):182-185.nFeltes TF, Bacha E, Beekman RH 3rd, Cheatham JP, et al. 2011. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation. 123(22):2607-2652.nJayasuriya C, Moss RR, Munt B. 2011. Transcatheter aortic valve implantation in aortic stenosis: the role of echocardiography. J Am Soc Echocardiogr 24(1):15-27.nKrishnaswamy A, Griffin BP. 2012. Challenges in the management of aortic stenosis. Cleve Clin J Med 79(7):483-486.nLababidi Z, Wu JR, Walls JT. 1984. Percutaneous. Balloon aortic valvuloplasty: results in 23 patients. Am J Cardiol 53(1):194-197.nLerakis S, Babaliaros VC, Block PC, et al. 2010. Transesophageal echocardiography to help position and deploy a transcatheter heart valve. JACC Cardiovasc Imaging 3(2):219-221.nMaskatia SA, Ing FF, Justino H, et al. 2011. Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis. Am J Cardiol 108(7): 1024-1028.n
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