Outcomes of Balloon Dilatation in Pediatric Severe Aortic Stenosis or Coarctation with Left Ventricular Dysfunction: A Cohort Study from a Tertiary Cardiac Center

Abstract

Objectives: To evaluate echocardiographic and clinical outcomes following balloon aortic valvuloplasty (BAV) or balloon angioplasty (BA) in pediatric patients with severe AS or CoA and left ventricular ejection fraction (LVEF) <35%. Methodology: This retrospective and prospective cohort study included 49 pediatric patients who underwent BAV (n=20) or BA for CoA (n=29) at the National Institute of Cardiovascular Diseases (NICVD), Karachi. Serial transthoracic echocardiography and clinical assessments were performed at baseline, 1 month, and 6 months post-procedure. Results: The mean age was 6.4 ± 3.1 months, with 57% being male. Significant improvements were observed across both groups. In the AS group, median LVEF improved from 35% to 53% (p < 0.001) at 6 months, alongside reductions in LV end-diastolic diameter (LVEDD) and normalization of diastolic indices (E/A ratio from 2.2 to 1.4, p = 0.002). The CoA group demonstrated an increase in LVEF from 30% to 51% (p < 0.001) and a 77.5% reduction in pressure gradients. All patients initially presented in cardiogenic shock requiring inotropic support; by follow-up, only 10% remained on inotropes. Lactate, pH, and NT-proBNP levels also showed marked improvement. Overall mortality was 10.2%, primarily occurring in the immediate post-procedural period among the most critically ill. Conclusion: Balloon dilatation significantly improves ventricular function and clinical status in pediatric patients with severe AS or CoA and profound LV dysfunction. Timely intervention can disrupt the cycle of myocardial injury and promote cardiac remodeling, even in critically ill infants within resource-limited settings.