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Intermediate-term outcome after pulmonary balloon valvuloplasty: comparison with a matched surgical control group
B K O'Connor1, R H Beekman, A Lindauer
1Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor 48109-0204.
Insights
Late pulmonary balloon valvuloplasty in children shows comparable gradient reduction to surgery. Valvuloplasty patients experienced less pulmonary valve insufficiency and ventricular ectopic activity long-term.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Childhood pulmonary stenosis often requires intervention.
- Pulmonary balloon valvuloplasty and surgical valvotomy are common treatment options.
- Long-term outcomes comparing these methods are crucial for clinical decision-making.
Purpose of the Study:
- To evaluate late gradient reduction after childhood pulmonary balloon valvuloplasty.
- To compare the effectiveness of valvuloplasty versus surgical valvotomy in the long term.
Main Methods:
- Prospective, noninvasive evaluation of 20 children treated with balloon valvuloplasty and matched surgical controls.
- Late assessment included clinical exams, echocardiography, Doppler, Holter monitoring, ECG, exercise treadmill tests, and chest X-rays.
- Follow-up averaged 5.3 years post-valvuloplasty and 11.7 years post-surgery.
Main Results:
- No restenosis observed in the balloon valvuloplasty group.
- Late residual pulmonary stenosis gradients were similar between groups (24 +/- 2.7 mm Hg vs. 16 +/- 1.5 mm Hg).
- Significant differences noted in pulmonary valve insufficiency and ventricular ectopic activity, favoring valvuloplasty.
Conclusions:
- Pulmonary balloon valvuloplasty offers effective late gradient reduction in children.
- Valvuloplasty appears to result in less pulmonary valve insufficiency and ventricular ectopy compared to surgery.
- Both interventions provide comparable hemodynamic outcomes in the long term.
Abstract:
To assess late (4 to 5 years) gradient reduction after pulmonary balloon valvuloplasty in childhood, and to compare the effectiveness of valvuloplasty with that of surgical valvotomy, 20 valvuloplasty-treated children and their age- and gradient-matched surgical control patients underwent prospective, noninvasive evaluation. The average age at intervention was 4.3 +/- 1 years for the valvuloplasty group versus 4.7 +/- 0.8 years for the surgical control group (p = NS). Before intervention the peak systolic pulmonary stenosis gradient was 76 +/- 5 and 74 +/- 4.4 mm Hg for the valvuloplasty and surgery groups, respectively (p = NS). Late evaluation consisted of clinical examination, two-dimensional echocardiogram and Doppler study, 24-hour Holter monitoring, 12-lead electrocardiogram, exercise treadmill study and chest radiograph performed an average of 5.3 +/- 0.3 years after valvuloplasty and 11.7 +/- 0.5 years after surgery (p less than 0.01). The patients treated with balloon valvuloplasty had no evidence of restenosis; the residual pulmonary stenosis gradient at follow-up was 24 +/- 2.7 mm Hg (range 8 to 48) versus 35 +/- 3.6 mm Hg (range 19 to 70) immediately after valvuloplasty (p = NS). Comparison of the late residual gradients between treatment groups showed no hemodynamically significant difference (24 +/- 2.7 versus 16 +/- 1.5 mm Hg, balloon versus surgery; p less than 0.01). However, there was, a significant difference in the degree and severity of pulmonary valve insufficiency and ventricular ectopic activity between groups. In the balloon valvuloplasty group 11 patients had no pulmonary insufficiency, and the remaining 9 had mild insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)