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[Percutaneous balloon valvuloplasty for severe and critical pulmonary valve stenosis in infants under six months]
Fang Liu1, Lin Wu, Guo-ying Huang
1Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China. liufanga@hotmail.com
Insights
Percutaneous balloon valvuloplasty offers a safe and effective treatment for infants with severe pulmonary valve stenosis. This minimally invasive procedure is a viable alternative to surgery, showing excellent outcomes and reduced complications.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary valve stenosis (PVS) is a significant congenital heart defect in infants.
- Severe and critical PVS often necessitates timely intervention to prevent adverse outcomes.
- Surgical valvotomy has been the traditional treatment, carrying inherent risks in neonates and young infants.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous balloon valvuloplasty (PBV) in infants with severe and critical PVS.
- To determine PBV's potential as an alternative to surgical intervention.
- To assess the long-term outcomes of PBV in this pediatric population.
Main Methods:
- Eighteen infants (8 days to 6 months) with severe/critical PVS underwent PBV.
- Procedures utilized general anesthesia with intubation or caudal block with sedation.
- Dilatation involved single or sequential balloon use; 11 infants had critical PVS, 5 with severe tricuspid regurgitation.
Main Results:
- PBV achieved an 88.9% success rate, significantly reducing the RV-PA pressure gradient from 87±24 mmHg to 30±19 mmHg (P<0.01).
- Complications included one case of failure to cross the valve and one of cardiac tamponade; no intra- or post-procedural complications occurred in others.
- Follow-up (6-32 months) showed sustained or improved gradients in 16 patients, with a 12.5% re-dilatation rate; tricuspid regurgitation improved, and mild pulmonary regurgitation was noted in most.
Conclusions:
- Percutaneous balloon valvuloplasty is a relatively safe and effective treatment for severe and critical pulmonary stenosis in infants.
- PBV presents a valid alternative to surgical operations, offering less trauma and fewer complications.
- This interventional approach should be considered the primary treatment option for eligible infants due to its excellent outcomes.
Objective:
To assess the effects and potential role of percutaneous balloon valvuloplasty as an alternative therapy of surgery in young infants with severe and critical pulmonary valve stenosis.
Methods:
Eighteen patients aged 8 days to 6 months with severe and critical pulmonary valve stenosis admitted to our hospital from June 2006 to August 2008 underwent balloon valvuloplasty. Among them, 11 infants including 2 neonates had critical pulmonary stenosis. Severe tricuspid regurgitation was seen in 5 and moderate in 3. Right ventricular systolic pressure in all patients was greater than systemic pressure with right-to-left or bi-directional shunt at atrial level. Dilatation was performed under general anesthesia with intubation in 12 patients and caudal block combined with sedation in 6 patients. Dilatation with 2 balloons sequentially in one procedure was performed in 6 patients and dilatation with 1 balloon in other 10 patients.
Results:
Of the 18 patients, there was failure to cross the pulmonary valve with balloon catheter in one and cardiac tamponade in one. The dilatation success rate was 88.9%. Immediately after dilatation, the systemic pressure gradient from right ventricle to pulmonary artery decreased from (87 +/- 24) mm Hg to (30 +/- 19) mm Hg (P < 0.01). No complication was found in all patients during or post dilation. During a follow-up of 6 to 32 months, pressure gradient crossing pulmonary valve measured by echocardiography further decreased or remained stable in 16 cases, except one neonate and one infant whose pressure gradient gradually increased and required a second dilatation. Re-dilatation rate was 12.5%. Tricuspid regurgitation was reduced in all patients. Mild pulmonary regurgitation was seen in most of patients post-dilatation, except moderate in one. All patients fared well and stayed asymptomatic.
Conclusion:
Percutaneous balloon valvuloplasty for severe and critical pulmonary stenosis in infants is relatively safe and effective and should be considered a valid alternative to surgical operation. It should be the first choice for such patients based on its excellent outcome, less trauma and fewer complications.
