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Rapid right ventricular pacing for balloon aortic valvuloplasty: expanding its routine use in neonates and infants

Published online by Cambridge University Press:  06 October 2020

Konstantinos S. Mylonas Open the ORCID record for Konstantinos S. Mylonas [Opens in a new window] ,
Charalampos Kavvouras ,
Panagiota Karouli ,
Dimosthenis Avramidis ,
Ioannis Papagiannis ,
David Anderson ,
Fotios Mitropoulos  and
Aphrodite Tzifa Open the ORCID record for Aphrodite Tzifa [Opens in a new window]
Konstantinos S. Mylonas
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens, Greece Department of Pediatric Cardiac Surgery, Mitera Children’s Hospital, Athens, Greece
Charalampos Kavvouras
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens, Greece
Panagiota Karouli
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens, Greece
Dimosthenis Avramidis
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens, Greece
Ioannis Papagiannis
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens, Greece
David Anderson
Affiliation:
Department of Pediatric Cardiac Surgery, Mitera Children’s Hospital, Athens, Greece Division of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
Fotios Mitropoulos
Affiliation:
Department of Pediatric Cardiac Surgery, Mitera Children’s Hospital, Athens, Greece
Aphrodite Tzifa*
Affiliation:
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens, Greece Division of Biomedical Engineering and Imaging Sciences, King’s College, London, UK
*
Author for correspondence: Aphrodite Tzifa MD (Res), FRCPCH, Director of Pediatric Cardiology and Adult Congenital Heart Disease Department, Mitera Children’s Hospital, Hygeia Group, Erythrou Stavrou 6, Athens 15123, Greece. Tel: + 30 6908999961; Fax: + 30 2106869197. E-mail: a.tzifa@btinternet.com
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Abstract

Objective:

Rapid right ventricular pacing during balloon aortic valvuloplasty is commonly used to achieve balloon stability in children and adults. There is no consensus for the use of the technique in neonates and infants. We sought to review our institutional experience with rapid right ventricular pacing-assisted balloon aortic valvuloplasty across all age groups and evaluate the safety and effectiveness of the technique in the sub-group of neonates and infants <12months.

Methods:

Retrospective study between February, 2011 and February, 2020.

Results:

A total of 37 patients (Group I: 21 neonates/infants <12months and Group II: 16 children 12 months–16 years) were analysed. Catheter-measured left ventricular to aortic gradient reduced from median of 66 mmHg (with a range from 30 to 125 mmHg) to 14 mmHg (with a range from 5 to 44 mmHg) in Group I and 44 mmHg (with a range from 28 to 93 mmHg) to 18 mmHg (with a range from 2 to 65 mmHg) in Group II (p < 0.001). Procedure and fluoroscopy times were identical in the two groups. Balloon:annulus ratio was 0.94 and 0.88 in Groups I and II, respectively. Freedom from reintervention was 100% for Group I at a median time of 3.2 years and 81% at 2.7 years for Group II. Reinterventions in Group II (3/16 pts) were performed predominantly for complex left ventricular outflow tract stenosis. At follow-up echocardiogram, 45% of patients in Group I had no aortic regurgitation, 30% trace-mild, 20% mild-moderate, and 5% moderate aortic regurgitation, whereas in Group II, 50% of patients had no aortic regurgitation, 32% had mild aortic regurgitation, and 18% mild-moderate aortic regurgitation. Unicuspid valves were only encountered in Group 1 (2/21 pts, 10%) and they were predictive of mild-aortic regurgitation during follow-up (p = 0.003). Ventricular fibrillation occurred in three neonates with suspicion of myocardial ischemia on the pre-procedure echocardiogram. All were successfully defibrillated.

Conclusions:

Rapid right ventricular pacing can be expanded in neonates and infants to potentially decrease the incidence of aortic regurgitation and reintervention rates, hence avoiding high-risk surgical bail-out procedures for severe aortic regurgitation in the first year of life. Myocardial ischemia may predispose to ventricular dysrhythmias during rapid right ventricular pacing.

Keywords

Rapid right ventricular pacingballoon aortic valvuloplastycongenital aortic valve stenosisneonatesinfants
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1890 - 1895
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Kitchiner, D, Jackson, M, Malaiya, N, Walsh, K, Peart, I, Arnold, R. Incidence and prognosis of obstruction of the left ventricular outflow tract in Liverpool (1960–91): a study of 313 patients. Br Heart J 1994; 71: 588–595.CrossRefGoogle ScholarPubMed
Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
Keane, JF, Driscoll, DJ, Gersony, WM, et al. Second natural history study of congenital heart defects. Results of treatment of patients with aortic valvar stenosis. Circulation 1993; 87 (Suppl 2): I16–I27.Google ScholarPubMed
Hill, GD, Ginde, S, Rios, R, Frommelt, PC, Hill, KD. Surgical valvotomy versus balloon valvuloplasty for congenital aortic valve stenosis: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5: e003931.CrossRefGoogle ScholarPubMed
David, F, Sanchez, A, Yanez, L, et al. Cardiac pacing in balloon aortic valvuloplasty. Int J Cardiol 2007; 116: 327–330.CrossRefGoogle ScholarPubMed
Daehnert, I, Rotzsch, C, Wiener, M, Schneider, P. Rapid right ventricular pacing is an alternative to adenosine in catheter interventional procedures for congenital heart disease. Heart (Br Cardiac Soc) 2004; 90: 1047–1050.CrossRefGoogle ScholarPubMed
Mehta, C, Desai, T, Shebani, S, Stickley, J, Giovanni, JDE. Rapid ventricular pacing for catheter interventions in congenital aortic stenosis and coarctation: effectiveness, safety, and rate titration for optimal results. J Interv Cardiol 2010; 23: 7–13.CrossRefGoogle ScholarPubMed
Sanchez, A, David, F, Velazquez, E, et al. Balloon stabilization by means of cardiac stimulation during aortic valvuloplasty. Arch Cardiol Mexico 2005; 75: 455–459.Google ScholarPubMed
Ing, FF, Boramanand, NK, Mathewson, J, Maginot, K, Perry, JC. Transcatheter aortic valvuloplasty assisted by right ventricular pacing. J Am Coll Cardiol 2002; 39 (Suppl 2): 412.CrossRefGoogle Scholar
Li, YQ, Wang, HS, Qin, YZ. Percutaneous balloon aortic valvuloplasty with rapid ventricular pacing in the right ventricle in managing congenital aortic valve stenosis in infants: report of 2 cases. Zhonghua er ke za zhi = Chin J Pediatr 2011; 49: 710–711.Google ScholarPubMed
Song, Y, Li, J, Zeng, G, et al. Efficacy and experience in right ventricular pacing-percutaneous balloon aortic valvuloplasty. Zhonghua er ke za zhi = Chin J Pediatr 2014; 52: 703–705.Google ScholarPubMed
Gupta, SD, Das, S, Ghose, T, Sarkar, A, Goswami, A, Kundu, S. Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis – a retrospective case series analysis. Ann Cardiac Anaesth 2010; 13: 236–240.CrossRefGoogle ScholarPubMed
Alva, C, Sanchez, A, David, F, et al. Percutaneous aortic valvoplasty in congenital aortic valvar stenosis. Cardiol Young 2002; 12: 328–332.CrossRefGoogle ScholarPubMed
McCrindle, BW. Independent predictors of immediate results of percutaneous balloon aortic valvotomy in children. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Am J Cardiol 1996; 77: 286–293.CrossRefGoogle ScholarPubMed
Galal, O, Rao, PS, Al-Fadley, F, Wilson, AD. Follow-up results of balloon aortic valvuloplasty in children with special reference to causes of late aortic insufficiency. Am Heart J 1997; 133: 418–427.CrossRefGoogle ScholarPubMed
Brown, DW, Dipilato, AE, Chong, EC, Lock, JE, McElhinney, DB. Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis intermediate and late follow-up. J Am Coll Cardiol 2010; 56: 1740–1749.CrossRefGoogle ScholarPubMed
Harrison, GJ, How, TV, Vallabhaneni, SR, et al. Guidewire stiffness: what’s in a name? J Endovasc Ther 2011; 18: 797–801.CrossRefGoogle Scholar
Mehta, C, Shebani, S, Grech, V, Degiovanni, J. How to achieve balloon stability in aortic valvuloplasty using rapid ventricular pacing. Images Paediatr Cardiol 2004; 6: 31–37.Google ScholarPubMed
De Giovanni, JV, Edgar, RA, Cranston, A. Adenosine induced transient cardiac standstill in catheter interventional procedures for congenital heart disease. Heart (Br Cardiac Soc) 1998; 80: 330–333.Google ScholarPubMed
Hashimoto, T, Young, WL, Aagaard, BD, Joshi, S, Ostapkovich, ND, Pile-Spellman, J. Adenosine-induced ventricular asystole to induce transient profound systemic hypotension in patients undergoing endovascular therapy: dose-response characteristics. Anesthesiology 2000; 93: 998–1001.CrossRefGoogle ScholarPubMed
Karagoz, T, Aypar, E, Erdogan, I, Sahin, M, Ozer, S, Celiker, A. Congenital aortic stenosis: a novel technique for ventricular pacing during valvuloplasty. Catheter Cardiovasc Interv 2008; 72: 527–530.CrossRefGoogle ScholarPubMed
Ertugrul, I, Karagoz, T, Celiker, A, Alehan, D, Ozer, S, Ozkutlu, S. The impact of rapid left ventricular pacing during pediatric aortic valvuloplasty on postprocedural aortic insufficiency. Congenit Heart Dis 2016; 11: 584–588.CrossRefGoogle ScholarPubMed
Balmer, C, Beghetti, M, Fasnacht, M, Friedli, B, Arbenz, U. Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart (Br Cardiac Soc) 2004; 90: 77–81.CrossRefGoogle ScholarPubMed
Ewert, P, Bertram, H, Breuer, J, et al. Balloon valvuloplasty in the treatment of congenital aortic valve stenosis – a retrospective multicenter survey of more than 1000 patients. Int J Cardiol 2011; 149: 182–185.CrossRefGoogle ScholarPubMed
Petit, CJ, Gao, K, Goldstein, BH, et al. Relation of aortic valve morphologic characteristics to aortic valve insufficiency and residual stenosis in children with congenital aortic stenosis undergoing balloon valvuloplasty. Am J Cardiol 2016; 117: 972–979.CrossRefGoogle ScholarPubMed
Luciani, GB, Lucchese, G, Carotti, A, et al. Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry. Heart (Br Cardiac Soc) 2014; 100: 1954–1959.Google ScholarPubMed
McElhinney, DB, Lock, JE, Keane, JF, Moran, AM, Colan, SD. Left heart growth, function, and reintervention after balloon aortic valvuloplasty for neonatal aortic stenosis. Circulation 2005; 111: 451–458.CrossRefGoogle ScholarPubMed
Peters, M, Krings, G, Koster, M, Molenschot, M, Freund, MW, Breur, JM. Effective radiation dosage of three-dimensional rotational angiography in children. EP Europace 2015; 17: 611–616.CrossRefGoogle ScholarPubMed
Slicker, K, Lane, WG, Oyetayo, OO, et al. Daily cardiac catheterization procedural volume and complications at an academic medical center. Cardiovasc Diagn Ther 2016; 6: 446–542.CrossRefGoogle ScholarPubMed
Tzifa, A, Avramidis, D, Patris, K. Coronary artery thrombosis in a neonate with critical aortic stenosis. J Invasive Cardiol 2019; 31: E91–E92.Google Scholar
Brown, JW, Rodefeld, MD, Ruzmetov, M, Eltayeb, O, Yurdakok, O, Turrentine, MW. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg 2012; 94: 146–153; discussion 153–145.CrossRefGoogle ScholarPubMed
Siddiqui, J, Brizard, CP, Galati, JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol 2013; 62: 2134–2140.CrossRefGoogle ScholarPubMed
Han, RK, Gurofsky, RC, Lee, KJ, et al. Outcome and growth potential of left heart structures after neonatal intervention for aortic valve stenosis. J Am Coll Cardiol 2007; 50: 2406–2414.CrossRefGoogle ScholarPubMed
Hochstrasser, L, Ruchat, P, Sekarski, N, Hurni, M, von Segesser, LK. Long-term outcome of congenital aortic valve stenosis: predictors of reintervention. Cardiol Young 2015; 25: 893–902.CrossRefGoogle ScholarPubMed
Donald, JS, Konstantinov, IE. Surgical aortic valvuloplasty versus balloon aortic valve dilatation in children. World J Pediatr Congenit Heart Surg 2016; 7: 583–591.CrossRefGoogle ScholarPubMed