chapter  10
8 Pages

Aortic valvuloplasty complications

WithAlexander J Javois

Concerns for major complications related to balloon aortic valvuloplasty have been documented ever since Lababidi first reported its application in humans in 1983.1

Not surprisingly,with expanded knowledge and enhanced technology, major complications have diminished. However, the improved and miniaturized equipment has motivated pediatric interventionalists to attempt smaller patients, bringing additional concerns not initially realized. Complications of aortic balloon valvuloplasty can be broadly categorized as vascular, valvular, myocardial, and embolic. The incidence of all complications is greater in the neonate.Mortality from all causes is < 2% in older children, but is 5% in non-duct-dependent and as high as 38% in ductal-dependent neonates.2,3

Vascular complications include pulse loss, vessel aneurysm, dissection, rupture, aortic perforation, and aortic arch intimal tears. Death from acute iliac artery tear in a neonate has been reported.3 The smaller the child, the higher the likelihood of vascular complications. In the initial report of the Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry in 1990, in which 204 procedures were reported, there was a 12% incidence of femoral thrombosis or damage, which was successfully treated in 80% of cases.4 In the 1996 follow-up VACA Registry report of 630 procedures, transection of the femoral or iliac artery was seen in 2.1% of patients.2 The incidence of pulse loss has been reported to be as high as 7%;5 the need for surgical intervention is less than 1%. Pulse loss may also be asymptomatic and permanent. Egito reported in 1997 a series of 33 neonates of which 20 had the retrograde femoral approach.6 All 20 (100%!) had pulse loss and were treated with thrombolytic therapy. The pulse returned in 35%. At mid term follow-up (on average 4.3 ± 1.8 years), 9/20 (45%) still had absent femoral pulse but no obvious leg discrepancy. Extremity growth retardation has been reported, but its exact incidence is unknown.7