Percutaneous balloon aortic valvuloplasty at the Queen Sirikit National Institute of Child Health: 25 years' experience.

BACKGROUND: Percutaneous balloon aortic valvuloplasty (BAV) is the treatment of choice in moderate and severe valvular aortic stenosis. In Thailand, the first procedure was performed at the Queen Sirikit National Institute of Child Health (QSNICH) in 1988. No previous studies have been reported regarding the outcome of these procedures at QSNICH. OBJECTIVE: To study the efficacy and complications of percutaneous balloon aortic valvuloplasty in the treatment of severe aortic stenosis. MATERIAL AND METHOD: A retrospective study from the medical records was performed. All patients with a diagnosis of moderate or severe valvular aortic stenosis treated with BAV from January 1988-December 2012 were recruited. Before 2008, the procedures were performed under local anesthesia with light systemic sedation. After that, most of the cases were performed under general anesthesia. The response to treatment was classified as good response, partial response or failure. The short-term complications were classified as vascular complications, arrhythmias and others. RESULTS: Sixty-eight recorded attempts on 60 patients (47 males = 71.67%) were enlisted in the study. The ages at the time of procedures ranged from 1 day to 15 years (mean 65.25, SD 53.54, median 51 months). Fourteen cases were under one year of age (20.58%). Immediate success comprised 85.29% with 65.51% classified as good response. Ten failures in nine cases all occurred before 1997. One of the cases was an attempted balloon aortic valvuloplasty with repeated failure. Three of the cases underwent open aortic valvuloplasty where one case (33.33%) survived. The other six cases refused to continue treatment and were lost to follow-up. Four deaths were reported. Repeated balloon aortic valvuloplasties were performed in eight cases. During the early phases (1988-1996), failures and mortality rates were extremely high. Experience and improved technology improved outcomes. Excluding the four dead cases, the only significant major complication occurred in a three-year-old boy with severe aortic stenosis who tore the chordae tendinae, producing severe, acute mitral regurgitation, together with ventricular tachycardia, requiring direct current cardioversion during the procedure and double valvuloplasty five years later. Other minor complications included transient cardiac arrhythmia in 12 cases, partial occlusion of femoral artery in 11 cases and groin hematoma in 8 cases. CONCLUSION: Percutaneous balloon aortic valvuloplasty was effective and safe for the treatment of moderate and severe aortic valve stenosis in pediatric patients without significant complications.