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Balloon valvuloplasty in dysplastic pulmonary valve stenosis: immediate and intermediate outcomes
Tayyaba Sehar1, Ahmad Usaid Qureshi1, Uzma Kazmi1
1Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore.
Insights
Balloon valvuloplasty for dysplastic pulmonary valve stenosis in children yielded suboptimal outcomes compared to doming valves. However, it offers good intermediate freedom from re-intervention, suggesting intervention at moderate severity may improve results.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary valve stenosis (PVS) is a common congenital heart defect.
- Dysplastic PVS and doming PVS represent distinct anatomical subtypes with potentially different treatment outcomes.
- Balloon valvuloplasty is a primary intervention for severe PVS in children.
Purpose of the Study:
- To compare immediate and intermediate outcomes of balloon valvuloplasty in children with dysplastic PVS versus doming PVS.
- To identify factors associated with unsuccessful outcomes and re-intervention in pediatric PVS treated with balloon valvuloplasty.
Main Methods:
- An interventional study conducted at The Children's Hospital, Lahore, Pakistan (June 2006 - December 2012).
- 152 children with severe PVS underwent balloon valvuloplasty, categorized into dysplastic (Group A, n=73) and doming (Group B, n=79) types.
- Outcomes were assessed based on residual gradient, re-intervention rates, and factors influencing success using statistical analysis (t-test, Mann Whitney U, Chi square, Kruskal-Wallis, multivariate analysis, Kaplan-Meier).
Main Results:
- Mean gradient reduced from 96 ± 33 mmHg to 29 ± 20 mmHg post-procedure.
- Dysplastic PVS (Group A) showed a higher rate of unsuccessful outcomes (9.6%, p=0.02) compared to doming PVS (Group B).
- Pre-procedure gradient > 75 mmHg was linked to unsuccessful outcomes, while immediate post-procedure gradient > 60 mmHg predicted re-intervention in Group A. Freedom from re-intervention at 6 years was 78.9% for Group A vs. 96.5% for Group B.
Conclusions:
- Balloon valvuloplasty for dysplastic PVS in children yields less optimal results than for doming PVS.
- Despite this, dysplastic PVS treatment demonstrates a high intermediate freedom from re-intervention.
- Considering intervention at moderate PVS severity may lead to improved outcomes.
Objective:
To determine the immediate and intermediate outcome in dysplastic and doming pulmonary valve stenosis in children and to determine various factors associated with unsuccessful outcome.
Study Design:
An interventional study.
Place And Duration Of Study:
The Children's Hospital, Lahore, Pakistan, from June 2006 to December 2012.
Methodology:
All patients presenting with severe pulmonary valve stenosis were enrolled in the study. Balloon valvuloplasty was performed on all patients. Successful outcome (residual gradient < 36 mmHg) was compared with matched doming pulmonary valve stenosis control group valvuloplasty. Difference in various quantitative variables was calculated using independent t-test and Mann Whitney U test. Categorical variables were compared using Chi square and Kruskal-Wallis test. Multivariate analysis was performed to determine various factors associated with outcome. Kaplan- Meier survival table was used to determine freedom from re-intervention proportions.
Results:
One hundred and fifty two patients (Dysplastic group A, n=73; Doming group B, n=79) with median age of 24 months (range 3 - 192 months) and M:F; 2:1 were included in the study. Mean gradient decreased from 96 ± 33 mmHg to 29 ± 20 mmHg. Group A had significantly higher number of patients with unsuccessful outcome (9.6%, p=0.02). Preprocedure gradient > 75 mmHg was the most significant factor associated with unsuccessful outcome (p < 0.001). Median follow-up duration was 3 years (range 1 - 6 years). Freedom from re-intervention proportion at 1, 3 and 6 years was 91.3%, 86.7% and 78.9% respectively in group A compared to 100%, 96.5% and 96.5% respectively in group B. Immediate postprocedure gradient > 60 mmHg was the only significant factor associated with re-intervention in group A (p=0.001).
Conclusion:
The results from balloon valvuloplasty in dysplastic pulmonary valve were suboptimal when compared to doming valves. However, it provides a high freedom from re-intervention rate in intermediate follow-up. Intervention at moderate severity can result in better outcome.
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