Aortic valve morphology is associated with outcomes following balloon valvuloplasty for congenital aortic stenosis: Reflection on morphological retrospection aids selection for interventional rejection

This very welcome comprehensive article of a sizeable series of balloon aortic valvuloplasties from a large and respected interventional stable should shape practice and in doing so may save lives. In summary, stenotic aortic valves with “better” morphology have greater and more enduring relief of obstruction and less regurgitation. The authors respectfully acknowledge that the article spans at least two eras of interventional practice and that balloon technology and operator techniques have changed over this time. Recalcitrant interventionists may want to speak up on modern day results being likely to be better, and they are cordially invited to present their version of 147 patients before us. However, for pediatric interventions, objective data, were ever likely to be thus, and we must be gracious in accepting the results of a paper which will have taken a huge amount of work sourcing, reviewing, and analyzing outcome. I am hopeful that the work of Maskatia and his coworkers at Texas Children's Hospital in producing this paper will unite the sometimes surgical—intervention divide on the subject of treatment of severe aortic valve stenosis. Let's face it, historically, surgeons have not been entirely averse to balloon valvuloplasty themselves [1, 2]. We have published objectivity now, so decision making is easy. This is how the MDT is going to work: Clinical case presented, echocardiograms shown and discussed: Functionally bicuspid valves step this way to the cath lab, the rest, please follow the signs to the operating room. So that's easy then…. Except…patients with favorable anatomy for a balloon valvuloplasty are also likely the ones with favorable anatomy for a surgical valvotomy. However, with an overall freedom from any event of 86% following balloon valvuloplasty for a functionally bicuspid valve surely the selection logic proposed above would be acceptable to any clinical treatment strategy committee. No longer need there be drawn out discussion on the best treatment for children with severe aortic stenosis. We can both have bites at the cherry, just that for good reason, the cherries are different.