Abstract
Balloon aortic valvuloplasty (BAV) is performed in children with significant aortic stenosis (AS). Traditionally, contrast angiography measures the annulus and assesses aortic regurgitation (AR) after each dilation. Echocardiographic guidance is hypothesized to reduce contrast and radiation exposure, without compromising efficacy or safety. Patients < 10 kg undergoing bav from 2013 to 2022 were retrospectively investigated. agreement between echocardiographic and angiographic annulus measurements was assessed. echocardiogram-guided ebav and traditional angiogram-guided tbav outcomes were compared controlling for weight critical as and other congenital heart disease chd. twelve ebav and 19 tbav procedures were performed. the median age was 33days median weight was 4.3kg 7 patients 23 had critical as and 9 patients 29 had other chd. annulus measurements by intraprocedural echocardiography and angiography displayed excellent correlation icc 0.95 p>< 0.001). ebav patients received less contrast 0.5 vs 3.5ml kg p>< 0.01). five recent ebav procedures were performed contrast free. radiation exposure was not statistically different between the ebav and tbav groups 155 vs 313gym2 p=" 0.12)." one ebav patient 8 and 3tbav patients 16 p=" 0.62)" experienced serious adverse events. technical success gradient>< 35 mmhg and increase in ar by1 grade occurred in 11 ebav patients 92 and 16 tbav patients 84 p=" 0.22)." ar increased in 2 ebav patients 17 and 8 tbav patients 44 p=" 0.02)." ebav was associated with similar efficacy and significantly lower contrast exposure and risk of aortic regurgitation. there was strong agreement between aortic valve annulus measurements by intraprocedural echocardiography and angiography ultimately permitting contrast free bav.>
