Comparison of single and double balloon valvuloplasty in children with aortic stenosis

To compare the effectiveness of the single and double balloon techniques, the short-term results of percutaneous balloon valvuloplasty were assessed in two consecutive groups of children with valvular aortic stenosis. In 16 children (aged 3 months to 17 years) the single balloon technique was utilized; the ratio of balloon diameter to valve anulus diameter was 0.96 ± 0.03 (mean ± SEM). In 11 children (aged 3 months to 21 years) the double balloon technique was utilized in which two balloons are positioned across the valve and inflated simultaneously; the ratio of the balloon diameter sum to valve anulus diameter was 1.32 ± 0.05. The groups were similar in age, weight, cardiac output, prevalvuloplasty gradient and valve anulus diameter. Overall, valvuloplasty reduced the peak systolic gradient by 53% from 80 ± 4 to 38 ± 3 mm Hg (p < 0.0001). In the single balloon group the gradient decreased from 82 ± 6 to 46 ± 4 mm Hg (p < 0.0001), whereas in the double balloon group the gradient decreased from 76 ± 5 to 26 ± 4 mm Hg (p < 0.0001). The peak systolic gradient after valvuloplasty was 43% lower in the double balloon group (p < 0.01). Furthermore, the single balloon technique reduced the gradient by an average of 43% compared with a 67% reduction with the double balloon technique (p < 0.001). The short-term complications of valvuloplasty were similar, with an increase in aortic insufficiency occurring in three children in each group. Although not a randomized trial, the present study suggests that the double balloon approach may be superior to single balloon valvuloplasty for children with aortic stenosis.