Percutaneous pulmonary valvuloplasty with a double-balloon technique

Percutaneous pulmonary valvuloplasty with a double-balloon technique was used in eight patients, aged 10-40 years, in whom valvuloplasty with a single 20-mm balloon resulted in inadequate dilatation of the stenosis. The diameters of the additional balloon varied from 10 to 20 mm. Balloons were inflated manually at about 30-45 psi (206.7-310.1 kPa) and deflated immediately after disappearance of the balloon waist. The mean peak systolic pressure gradient was 85 mm Hg +/- 37 before valvuloplasty, and it decreased to 38 mm Hg +/- 28 afterward (P less than .05). Double-balloon dilation and simultaneous computed tomography were done in two cardiac specimens from adult cadavers. At inflations at 30 and 45 psi (206.7 and 310.1 kPa), the outflow tract was elongated, and the balloons also deformed into ovoid shape at the lower pressure. The double-balloon technique appears to be safe and effective for relief of pulmonary valvular stenosis in those cases in which single-balloon technique is inadequate, especially in older children and adults.