The purpose of this study was to report on 5-to-9-year follow-up data after balloon aortic valvuloplasty in children and to investigate causes of aortic valve insufficiency at follow-up. While the immediate and short-term results of balloon aortic valvuloplasty have been well documented, there is scanty information on long-term follow-up results.

During a 7.3-year period ending December 1992, 26 children, aged 0.13 to 20 years, underwent balloon aortic valvuloplasty with resultant reduction of peak-to-peak aortic valvar gradient from 70 ± 20 (mean ± SD) to 26 ± 12mmHg (p<0.001). None required immediate surgical intervention. At intermediate-term follow-up (10 ± 4 mo), 6 (23%) of 26 developed restenosis, requiring surgical (4) or repeat balloon (2) valvuloplasty. Clinical and echo-Doppler data 2 to 9 (median, 6) years following balloon valvuloplasty revealed residual peak instantaneous Doppler gradients of 27 ± 15mmHg (p<0.001), without restenosis beyond what was observed at midterm follow-up. However, significant aortic insufficiency developed in 7 (27%) patients although, none required intervention as yet. Actuarial intervention-free rates at 1,2,5, and 9 years, respectively were 80%, 76%, 76%, and 76%. In order to identify factors associated with development of aortic insufficiency, seventeen variables were examined by logistic regression analysis; Doppler-quantitated degree of aortic insufficiency one day following valvuloplasty is a predictor of significant aortic insufficiency at late follow-up. None of demographic, anatomic, physiologic and technical variables seem to be associated with aortic insufficiency.

Based on these data it is concluded that the follow-up results of balloon aortic valvuloplasty are generally encouraging although increasing aortic insufficiency with time, though not requiring intervention as yet, is of concern.