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Intervention in Patients with Critical Pulmonary Stenosis in the Ductal Stenting Era

Ilker Kemal Yucel1, Mustafa Orhan Bulut1, Mehmet Kucuk1

  • 1Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street Nr. 13, Üsküdar, Istanbul, Turkey.

Pediatric Cardiology
|April 2, 2016
PubMed

Insights

Balloon valvuloplasty (BVP) and ductal stenting (DS) show excellent outcomes for critical pulmonary stenosis (CPS) in neonates. Tricuspid valve Z scores and right ventricular morphology predict the need for further interventions.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Interventional Cardiology

Background:

  • Critical pulmonary stenosis (CPS) is a severe congenital heart defect requiring timely intervention.
  • Balloon valvuloplasty (BVP) and ductal stenting (DS) are established treatment modalities for CPS.

Purpose of the Study:

  • To evaluate the early and midterm outcomes of BVP in neonates with CPS.
  • To identify predictors for additional pulmonary blood flow and reintervention after BVP.

Main Methods:

  • Retrospective review of 56 neonates diagnosed with CPS from 2005-2014.
  • Analysis of echocardiographic, catheterization, and angiographic data before and after BVP.
  • Statistical analysis to determine predictors of reintervention and need for pulmonary blood flow augmentation.

Main Results:

  • BVP achieved successful outcomes in 98% of neonates.
  • 38% of patients required pulmonary blood flow augmentation, with 20 undergoing DS.
  • Tricuspid valve Z score < -1.93 and pulmonary valve Z score < -1.69 predicted the need for flow augmentation.
  • Bipartite right ventricle was a significant predictor for reintervention (OR 9.6).

Conclusions:

  • BVP and DS demonstrate excellent immediate outcomes in neonates with CPS.
  • Prophylactic DS in selected CPS patients appears safe and reasonable.
  • Predictive value of TV Z score, PV Z score, and RV morphology aids in management decisions.

Keywords:
Critical pulmonary stenosisDuctal stentingReintervention

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