Percutaneous valvuloplasty in neonates with severe and critical aortic stenosis: evolution and poor prognosis prediction

To the Editor, Critical, severe, and congenital aortic stenosis (AS) is challenging regarding the decision-making process, and has high mortality and morbidity rates,1 being percutaneous treatment the one more commonly used in most centers. The objective of this study was to assess the clinical and echocardiographic progression of congenital ASs treated with percutaneous valvuloplasty (PV), and the predictive factors of worse disease progression.2,3 RSevere (peak velocity > 4 m/s or mean gradient > 40 mmHg), and critical ASs (ductus-dependent systemic flow) were included retrospectively based on the first postnatal echocardiography diagnosed during the fetal stage and until the first month of life and then treated with PV in a tertiary center from 2009 through 2019. The criteria established by the Declaration of Helsinki were followed, and the patients’ informed consent was waived. Left ventricular ejection fraction (LVEF), endomyocardial fibroelastosis, flows in ductus, foramen ovale, ascending aorta, aortic arch, mitral regurgitation, and hydrops were all analyzed. The size and shape of the aortic valve, the size, function, and ventricular fibroelastosis at birth, the immediate control after PV and at the follow-up, the hemodynamic gradients of PV, and complications were collected. PV was considered effective with peak residual hemodynamic gradients ≤ 35 mmHg or 50%...