[Percutaneous aortic valvuloplasty in children, non invasive evaluation and criteria of success].

The results of percutaneous aortic valvuloplasty in 15 children (average 8.4 years) were evaluated by echocardiography and non-invasive criteria of the indication of this procedure were defined. The aortic valve was unthickened in 7 patients (Group I) and dystrophic in the other 8 (Group II). Valvuloplasty decreased the transvalvular pressure gradient by 47 +/- 33%. Aortic regurgitation was aggravated in 4 patients. The reduction in pressure gradient was significantly greater in Group I than in Group II (64 +/- 19% vs 31 +/- 35%, p < 0.05). In Group I, in contrast to Group II, the results remained stable after an average follow-up of 14.5 months. When the maximal instantaneous pressure gradient on Doppler examination was < 80 mmHg, the peak-to-peak gradient at catheterisation was on average 21% less, whereas when the Doppler gradient was 80 mmHg or more, the percentage difference was only 8%. The myocardial mass index was over the 95th percentile in 7/8 patients with gradients > 80 mmHg whilst it was only increased in 1 patient with a gradient < 80 mmHg. Electrocardiographic LVH was observed in 6 of the 8 patients with a gradient > 80 mmHg but in none of the others. Although valvuloplasty reduced the transvalvular pressure gradient, the results were much less satisfactory in the dystrophic valves. The following indications were proposed for this techniques: a Doppler maximal pressure gradient > or = 80 mmHg, associated with at least one criterion of left ventricular hypertrophy.