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Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Delayed success of balloon dilation for coexisting pulmonary valve stenosis and sinotubular narrowing
1Department of Pediatric Cardiology, Indiana University School of Medicine, Indianapolis, Ind, USA.
Insights
Balloon pulmonary valvuloplasty (BPV) effectively treats pulmonary valve stenosis (PVS) in children, even with sinotubular narrowing (STN). Most children benefit long-term, making BPV a safe first-line therapy.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary valve stenosis (PVS) is common in children.
- Balloon pulmonary valvuloplasty (BPV) is the preferred treatment for PVS.
- Sinotubular narrowing (STN) can complicate BPV outcomes, leading to surgical preference.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients with coexisting PVS and STN who underwent BPV.
- To compare the effectiveness of BPV in patients who avoided surgery versus those who required it.
Main Methods:
- Retrospective analysis of 23 pediatric patients with PVS and STN undergoing BPV.
- Comparison of total pulmonary gradient (TPG) before and after BPV, and at long-term follow-up.
- Stratification of patients into those who avoided surgery (Group 1) and those who required it (Group 2).
Main Results:
- Surgery was avoided in 65% of patients (Group 1).
- In Group 1, mean TPG decreased significantly post-BPV and at long-term follow-up (P < 0.01).
- In Group 2, TPG remained unchanged by BPV and prior to surgery (P > 0.10).
Conclusions:
- BPV has a limited acute impact on PVS with STN but offers significant long-term benefits for most children.
- BPV is a safe and effective first-line therapy for PVS, even with STN.
- Surgical repair should be reserved for patients with worsening clinical signs and symptoms post-BPV.
Objectives:
We evaluated the outcomes of children at a single institution who underwent balloon pulmonary valvuloplasty (BPV) for coexisting pulmonary valve stenosis (PVS) and sinotubular narrowing (STN).
Background:
BPV is the treatment of choice for PVS in children. Current practice favors surgical repair of moderate, severe, and symptomatic pulmonary stenosis when STN exists. This practice arose from lack of reduction in total pulmonary gradient (TPG) and frequent adverse events from BPV.
Methods:
A retrospective analysis of outcomes in children with coexisting PVS and STN following BPV at a single institution was performed.
Results:
Twenty-three patients were identified. Median age at BPV was 0.5 years (interquartile range (IQR) 0.3-2). Surgery was avoided in 15/23 (65%) (Group 1) and required in 8/23 (35%) (Group 2) following BPV. Group 1 had a mean baseline peak echo TPG of 60 mm Hg (±12) that decreased to 44 mm Hg (±10) following BPV (P < 0.01) and further to 21 mm Hg (±13) at 3.6 years (±2.2) following BPV (P < 0.01). Group 2 had a mean baseline peak echo TPG of 68 mm Hg (±17). TPG was unchanged by first echo after BPV at 56 mm Hg (±13) and just prior to surgery at 63 mm Hg (±15) (P > 0.10).
Conclusions:
BPV has minimal acute effect on PVS when STN exists; however; long-term benefits are achieved in most. BPV should be considered first-line therapy given its safety and effectiveness. Only those with worsening clinical signs and symptoms should be referred for surgical repair following BPV.
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