Echocardiographic changes following balloon valvuloplasty in valvular pulmonic and aortic stenosis

Nineteen patients with pulmonary valvular stenosis and two with aortic valvular stenosis, aged 20 days to 12 years, were studied before and after balloon dilatation valvuloplasty (BDV) by M-mode, 2-D, pulsed wave (PW) and continuous wave (CW) Doppler, and color flow mapping echocardiography. In those with pulmonary stenosis, a dome-shaped valve was found in 16(84%) of 19 cases before BDV, and the valve remained dome shaped only in 4(27%) of 15 after procedure (P less than 0.001). Restricted valve motion which was noted in 18(95%) of 19 before BDV, persisted only in 2(13%) of 15 after procedure (P less than 0.001). Thickening of the pulmonic valve and poststenotic dilatation of the main pulmonary artery stayed almost unchanged. The pressure gradient across the pulmonic valve measured by cardiac catheterization and CW Doppler agreed well (r = 0.862). Echocardiographic evidence of pulmonary regurgitation was detected in 1(25%) of 4 patients before, and 7(50%) of 14 after BDV. In two patients with aortic stenosis, the echocaardiograms showed the valve was thickened and dome-shaped. Following BDV, echocardiographic evidence of mild aortic regurgitation was observed only in one patient who had had such a regurgitationn before BDV. The diameter of the valve annulus measured on 2-D echo and angiocardiograms correlated well (r = 0.912), and it stayed unchanged following BDV. It is concluded that 2-D and Doppler echocardiographic examinations proved to be useful in the measurement of valve annulus, delineation of stenotic semilunar valves and monitoring of the efficacy of BDV.