Balloon Aortic Valvuloplasty (BAV)
What is BAV?
The aortic valve in the heart is located between the left ventricle and the aorta. Normally, the aortic valve structure has three leaflets but some babies are born with an aortic valve that has only two leaflets called a bicuspid valve. This bicuspid aortic valve may remain at the same stage throughout life or it may become progressively stenotic (narrow) or become leaky.
If the valve becomes too narrow Balloon aortic valvuloplasty (BAV) is used as a suitable treatment method in children. This procedure is done in the catheterization lab where a small balloon is inserted via a thin tube into an artery in the groin area (upper thigh). The balloon is inflated in the aortic valve which will increase blood flow to the heart.
Infants with aortic valve stenosis can rapidly get into a life threatening condition where early identification and immediate BAV is required.
Complications of BAV
The procedure is associated with potential complications. In 10-15% of instances the valve may leak significantly after the procedure. In a small proportion (<2%) it may require emergency surgery to repair the damaged valve. Additionally, the general complication of catheterisation can occur especially in small babies. The aortic valve is typically reached via the groin artery and this may get blocked after the procedure. After the procedure there may be a need for a variable period of supportive treatment. Selected newborns may need to be in the ICU and may require mechanical ventilatory support.
What can be expected over the long term?
It is often necessary to follow these patients carefully after BAV. The following issues need specific attention:
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The aortic valve may become narrow again.
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The aortic valve leakage may increase with time. Often after BAV, the aortic valve may have a small degree of leakage that is of no immediate consequence. But this may progress with time and eventually need surgery in the form of repair or, exceptionally, replacement.
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The aorta may dilate with time in patients with congenital abnormal aortic valves. This is now increasingly being recognized and needs echocardiography every year or two.