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Effectiveness of balloon valvuloplasty in the young adult with congenital aortic stenosis.

The objective of this study was to assess the effectiveness of balloon valvuloplasty in the young adult with congenital aortic stenosis and to compare its effectiveness with children. Percutaneous balloon valvuloplasty is effective in children with congenital aortic stenosis, but not in adults with acquired calcific aortic stenosis. Because effectiveness of balloon valvuloplasty in young adults with congenital aortic stenosis is not well defined, we evaluated the outcome in 15 patients aged 16-24 years (18 +/- 0.6; mean +/- SEM) who underwent balloon valvuloplasty from 1985 to 1993. The aortic valve annulus diameter ranged from 18.5 to 30 mm (24 +/- 0.9). The aortic valve was bicuspid in 12 and tricuspid in 3 patients, and calcification was present in one patient. Balloon valvuloplasty was performed using a double balloon technique in 12 patients and a single balloon technique in three patients. Three patients had inadequate relief of gradient with a residual peak systolic gradient > or = 70 mm Hg. Three patients required valve replacement-two patients for a residual gradient > or = 70 mg Hg, and one patient 4 years later for severe aortic valve regurgitation. Eight of the remaining 12 have undergone elective follow-up catheterization 1.2-2.5 years (1.5 +/- 0.1) later. The peak systolic aortic valve gradient decreased by 55% from 73 +/- 5.8 mm Hg to 35 +/- 5.4 mm Hg immediately postvalvuloplasty, and was 30 +/- 4.4 mm Hg at follow-up (P < 0.001). The left ventricular systolic pressure decreased from 179 +/- 7.5 to 147 +/- 6.5 mm Hg immediately postvalvuloplasty and was 147 +/- 4 mm Hg at follow-up. Aortic insufficiency was unchanged after valvuloplasty in 9, increased by 1+ in 4, and by 2+ in 2 patients. Balloon valvuloplasty was as effective in these young adults as in 70 children (age 6 +/- 0.7 years) with congenital aortic stenosis (peak systolic gradient pre- 79 +/- 3 mm Hg versus post- 34 +/- 2 mg Hg; at 1-2 years follow-up 34 +/- 4 mm Hg). Balloon valvuloplasty provides effective treatment in most young adults with congenital aortic stenosis, without early restenosis. Balloon valvuloplasty is as effective in young adults as in children, where it is currently the treatment of choice.