This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brown, D. W. Articles by Marshall, A. C. Search for Related Content PubMed PubMed Citation Articles by Brown, D. W. Articles by Marshall, A. C. Related Collections Valvular heart disease Catheter-based coronary and valvular interventions: other Pediatric and congenital heart disease, including cardiovascular surgery Related Article

Original Articles

Aortic Wall Injury as a Complication of Neonatal Aortic Valvuloplasty

Incidence and Risk Factors

David W. Brown, MD; Erin C. Chong, BA; Kimberlee Gauvreau, ScD; John F. Keane, MD; James E. Lock, MD and Audrey C. Marshall, MD

From the Department of Cardiology, Children’s Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Mass.

Correspondence to David W. Brown, MD, Department of Cardiology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail david.brown{at}cardio.chboston.org

Received March 5, 2008; accepted April 24, 2008.

Background— Transcatheter balloon aortic valvuloplasty for critical aortic stenosis in neonates is routinely performed without recognized complication. Aortic wall injury has rarely been observed after balloon aortic valvuloplasty, although the incidence of this complication is unstudied. We reviewed single-center data to determine the incidence of aortic injury during balloon aortic valvuloplasty and to identify risk factors.

Methods and Results— This retrospective study included all patients <2 months of age who underwent balloon aortic valvuloplasty at our institution from 1985 to 2007. We defined aortic wall injury as an intimal flap, dissection, or vessel rupture as diagnosed by angiography, echocardiography, or direct surgical or postmortem inspection. Primary imaging data were reviewed, as were all procedural and pathology reports, to identify cases of aortic wall injury. Patient and procedural variables were analyzed. Of 187 procedures performed, 28 procedures resulted in aortic wall injury (15%). Injury was recognized at the time of the procedure in only 16 cases (57%). Intimal flaps occurred most commonly in the distal ascending aorta (n=13), most often involving the greater curvature. In multivariate analysis, severe ventricular dysfunction at the time of the procedure (odds ratio, 2.8; P=0.02), greater number of balloon dilation attempts per procedure (odds ratio, 1.5; P=0.005), and novice interventional staff (odds ratio, 2.5; P=0.05) were associated with aortic injury. Incidence of injury was not different in the recent era compared with earlier experience.

Conclusions— Aortic wall injury, specifically creation of an intimal flap, is an underrecognized complication of neonatal balloon aortic valvuloplasty, occurring in 15% of cases even in the recent era. Only severe ventricular dysfunction, greater number of balloon dilations, and novice staff were associated with injury. The clinical sequelae of aortic wall injury remain incompletely understood.

Key Words: heart defects, congenital • valvuloplasty • balloon • catheterization • complications

---

 

CLINICAL PERSPECTIVE

Related Article

Aortic Wall Injury as a Complication of Neonatal Aortic Valvuloplasty: Incidence and Risk Factors

David W. Brown, Erin C. Chong, Kimberlee Gauvreau, John F. Keane, James E. Lock, and Audrey C. Marshall
Circ Cardiovasc Interv 2008 1: 53-59. [Abstract] [Full Text] [PDF]