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[Problems posed by percutaneous pulmonary valvuloplasty in children]
Insights
Balloon valvuloplasty is effective for pulmonary valve stenosis in young patients, with higher failure rates in neonates and infants. Post-procedure infundibular stenosis may improve spontaneously.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Context:
- Pulmonary valve stenosis (PVS) is a congenital heart defect affecting the pulmonary valve.
- Percutaneous balloon valvuloplasty is a minimally invasive treatment option for PVS.
- Efficacy and safety in pediatric populations require further investigation.
Purpose:
- To evaluate the success and complication rates of percutaneous balloon valvuloplasty in a cohort of young patients with pulmonary valve stenosis.
- To identify factors associated with procedural failure and success.
Summary:
- Percutaneous balloon valvuloplasty was attempted in 41 pediatric patients with pulmonary valve stenosis.
- The procedure was effective in 33 patients, with complete success in 7 and partial success in 8 of those with tight stenosis.
- Failure occurred in 8 cases, predominantly in younger children (<1 year), due to technical issues or complications like air embolism or infundibular perforation.
- Accentuation of infundibular stenosis post-dilatation was a common cause of failure, though spontaneous improvement was observed in some cases.
Impact:
- Percutaneous balloon valvuloplasty is a viable treatment for pulmonary valve stenosis in children, though careful patient selection and monitoring are crucial.
- Understanding failure mechanisms, such as infundibular stenosis, can guide procedural improvements and patient management.
- This study contributes to the evidence base for interventional cardiology in pediatric congenital heart disease.
Abstract:
Percutaneous valvuloplasty with a balloon catheter was attempted in 41 young patients with pulmonary valve stenosis. There were 9 neonates (1 to 7 days), 6 infants (1.5 to 7 months) and 26 children (16 months to 17 years). The attempt failed in 8 cases, either because the balloon could not be inserted due to intravenous progression problems or to quasi-atresia of the orifice, or because serious accidents (air embolism in one patient, perforation of the infundibulum in another) forced us to abandon the procedure before dilatation. Failures mostly occurred in very young children: 7 out of 15 aged less than 1 year, 1 out of 26 older than 1 year. Dilatation was effective in 33 cases. Among 13 patients who had moderate stenosis with infra- or iso-systemic right ventricular systolic pressure (RVP) (mean: 70 +/- 13 mmHg) and modest ventriculo-pulmonary gradient (49 +/- 12 mmHg), there was only 1 failure due to coexistent biventricular myocardiopathy; success was immediate and complete in 8 cases, partial in 4 cases. Among 20 children presenting with tight stenosis with supra-systemic RVP (164 +/- 39 mmHg) and high ventriculo-pulmonary gradient (140 +/- 43 mmHg), there were 5 failures; success was partial in 8 cases, complete and immediate in 7 cases. Accentuation of the infundibular stenosis after dilatation was a frequent cause of failure, as we have shown by calculating the infundibular "reactivity index" on pre- and post-operative angiocardiograms. In such cases one may hope for spontaneous improvement, as was indeed subsequently observed in 2 of our patients.(ABSTRACT TRUNCATED AT 250 WORDS)