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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Balloon aortic valvotomy (BAV) for aortic stenosis (AS) in adolescents and young adults BAV is indicated in the following settings is this population: • With symptoms of angina, syncope, or dyspnea on exertion and catheterization peak left ventricular (LV)-to-peak aortic gradient greater than or equal to 50 mmHg* in the absence of a heavily calcified valve. • For asymptomatic individuals with catheterization peak LV-to-peak aortic gradient >60 mmHg*. • For asymptomatic individuals with ST or T wave changes over the left precordium on the electrocardiogram (ECG) at rest or with exercise and a peak LV-to-peak aortic gradient >50 mmHg*. BAV is reasonable in the following settings in this population: • Asymptomatic individuals who want to play competitive sports or become pregnant who have a catheterization peak LV-to-peak aortic gradient >50 mmHg*. • BAV is probably recommended over valve surgery if BAV is possible. Such patients should be referred to a center with expertise with BAV. BAV should NOT be performed in the following setting in this population: • Asymptomatic individuals who, have a catheterization peak LV-to-peak aortic gradient <40 mmHg without symptoms or ECG changes. * The peak LV-to-peak aortic gradients are generally obtained with the patient sedated. The gradients may be somewhat lower if general anesthesia is used. Data from: Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.