Pediatric Cardiology and Cardiac Surgery
Vol.26 No.5 2010 (359-367)
Hirofumi Saiki,1) Teruo Tei,1, 3) Sachiko Kido,1) Toshikatsu Tanaka,1) Hideki Fujita,1) Kenta Tominaga,1) Yumi Sato,1) Yoshiharu Ogawa,1) and Yoshihiro Oshima2)
1)Department of Cardiology, 2)Cardiovascular Surgery, Hyogo Prefectural Kobe Children’s Hospital, 3)Tei Pediatric Clinic, Kobe, Japan
Background: Although there are various procedures to treat aortic valve stenosis (AS), the proper application of invasive procedures is an unresolved issue.
Methods: The subjects were 34 consecutive patients with AS who required interventions from 1989 to 2008. Twenty-four patients had no associated anomaly, and 10 patients had associated coarctation of the aorta (CoA). We reviewed the initial procedures and outcomes. The initial treatment adopted was the procedure that seemed most suitable for each patient according to the valve morphology, complicating anomaly, and clinical status. Percutaneous transluminal aortic valvuloplasty (PTAV) or open aortic commissurotomy (OAC) was usually selected, but in cases where the valve was considered to be inappropriate for plasty, either the Ross procedure or aortic valve replacement (Ross/AVR) was adopted.
Results: In patients with simple AS and AS with CoA, the age at intervention was 5.3±5.7 and 0.48±0.71 years, and the follow-up period was 8.8±5.4 and 5.9±6.1 years. The initial procedure was OAC (6), PTAV (9), and Ross/AVR (9); and OAC (4) and PTAV (6), respectively. The number of patients with simple AS who had re-interventions after PTAV, OAC, and Ross/AVR was 2 (22%), 5 (83%), and 2 (18%), respectively. There were 3 cases of mortality after initial Ross/AVR. The number of PTAV patients under 6 months old was larger (p<0.05) and the frequency of aortic regurgitation before the procedure was significantly lower (p<0.05) than those of the OAC patients. All patients with AS and CoA died after OAC. After PTAV, 3 patients (50%) required re-interventions, and one died of a non-cardiac event. Conclusions: When appropriate patients are selected, PTAV is a long-lasting initial intervention that has the advantage of being less invasive.