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Echocardiographic versus angiographic measurement of the aortic valve annulus in children undergoing balloon aortic valvuloplasty: method affects outcomes

Published online by Cambridge University Press:  14 October 2020

George T. Nicholson Open the ORCID record for George T. Nicholson [Opens in a new window] ,
Bryan H. Goldstein ,
Kevin Gao ,
Ritu Sachdeva ,
Sean M. Lang ,
Scott Gillespie ,
Sung-in H. Kim  and
Christopher J. Petit
George T. Nicholson*
Affiliation:
Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN, USA
Bryan H. Goldstein
Affiliation:
The Heart Institute, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Kevin Gao
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Ritu Sachdeva
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Sean M. Lang
Affiliation:
The Heart Institute, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Scott Gillespie
Affiliation:
Department of Biostatistics, Emory University School of Medicine, Atlanta, GA, USA
Sung-in H. Kim
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Christopher J. Petit
Affiliation:
Sibley Heart Center, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: George T. Nicholson, MD, Assistant Professor of Pediatrics, Vanderbilt University School of Medicine, 220 Children’s Way, Nashville, TN 37232, USA. Tel: +1 615 322 7447; Fax: +1 615 322 2210. E-mail: george.t.nicholson@vumc.org
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Abstract

Objective:

Operators are mindful of the balloon-to-aortic annulus ratio when performing balloon aortic valvuloplasty. The method of measurement of the aortic valve annulus has not been standardised.

Methods and results:

Patients who underwent aortic valvuloplasty at two paediatric centres between 2007 and 2014 were included. The valve annulus measured by echocardiography and angiography was used to calculate the balloon-to-aortic annulus ratio and measurements were compared. The primary endpoint was an increase in aortic insufficiency by ≥2 degrees. Ninety-eight patients with a median age at valvuloplasty of 2.1 months (Interquartile range (IQR): 0.2–105.5) were included. The angiographic-based annulus was 8.2 mm (IQR: 6.8–16.0), which was greater than echocardiogram-based annulus of 7.5 mm (IQR: 6.1–14.8) (p < 0.001). This corresponded to a significantly lower angiographic balloon-to-aortic annulus ratio of 0.9 (IQR: 0.9–1.0), compared to an echocardiographic ratio of 1.1 (IQR: 1.0–1.1) (p < 0.001). The degree of discrepancy in measured diameter increased with smaller valve diameters (p = 0.041) and in neonates (p = 0.044). There was significant disagreement between angiographic and echocardiographic balloon-to-aortic annulus ratio measures regarding “High” ratio of >1.2, with angiographic ratio flagging only 2/12 (16.7%) of patients flagged by echocardiographic ratio as “High” (p = 0.012). Patients who had an increase in the degree of aortic insufficiency post valvuloplasty, only 3 (5.5%) had angiographic ratio > 1.1, while 21 (38%) had echocardiographic ratio >1.1 (p < 0.001). Patients with resultant ≥ moderate insufficiency more often had an echocardiographic ratio of >1.1 than angiographic ratio of >1.1 There was no association between increase in balloon-to-aortic annulus ratio and gradient reduction.

Conclusions:

Angiographic measurement is associated with a greater measured aortic valve annulus and the development of aortic insufficiency. Operators should use caution when relying solely on angiographic measurement when performing balloon aortic valvuloplasty.

Keywords

Aortic valve diseaseCHDpaediatric intervention
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1923 - 1929
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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