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Percutaneous balloon pulmonary valvuloplasty in children: a 10-Year retrospective follow-up study in resource-limited
Mohammed Nasir1, Kefelegn Dejene2, Mohammed Bedru2
1Pediatrics and Child Health Department, Hawassa University, Hawassa, Ethiopia. mn2572338@gmail.com.
Insights
Percutaneous balloon pulmonary valvuloplasty (BPV) is effective for pulmonary stenosis, but follow-up is crucial. This study in Ethiopia found initial success but also noted risks of pulmonary regurgitation and restenosis over time.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Percutaneous balloon pulmonary valvuloplasty (BPV) is a primary treatment for pulmonary valve stenosis.
- Limited research exists on BPV outcomes in developing nations.
- This study evaluates BPV results at the Cardiac Center of Ethiopia.
Purpose of the Study:
- To assess the immediate and midterm outcomes of BPV in Ethiopian patients.
- To identify predictors of post-BPV pulmonary regurgitation and restenosis.
Main Methods:
- Retrospective chart review and phone interviews of 138 patients (≤18 years) who underwent BPV.
- Data collected from January 2012 to March 2023.
- Statistical analysis, including multivariable logistic regression, was used.
Main Results:
- BPV significantly reduced the peak pulmonary trans-valvular gradient (106 mmHg to 40 mmHg).
- Immediate success rate was 71% with 4.3% complications.
- At median 114-month follow-up, 34.1% developed moderate-to-severe pulmonary regurgitation, and 24.4% experienced restenosis.
Conclusions:
- Initial success with BPV is common, but pulmonary regurgitation and restenosis can develop later.
- Thorough follow-up is essential for early detection and management of complications.
- Predictors for adverse outcomes include balloon annulus ratio, valve morphology, and pressure gradients.
Background:
Percutaneous balloon pulmonary valvuloplasty (BPV) is the preferred treatment for pulmonary valve stenosis owing to its effectiveness and safety in patients with appropriate valves. However, there is a lack of research on the immediate and midterm results in developing nations. Thus, this study aimed to evaluate the immediate and midterm outcomes of patients who underwent BPV at the Cardiac Center of Ethiopia.
Methodology:
A follow-up study was conducted from April 2023 to August 2023 using retrospective chart reviews and phone interviews involving 138 patients aged ≤ 18 years who underwent balloon BPV for moderate to severe pulmonary stenosis (defined as peak pulmonary valvular gradient ≥ 50 mmHg) at the Cardiac Center of Ethiopia between January 2012 and March 2023. The study's primary objective was to assess the procedure's immediate success and mid-term outcomes. The study employed various statistical tests, including a multivariable logistic regression model, to identify predictors of the development of moderate to severe pulmonary regurgitation and restenosis.
Results:
The patients' median age was 3.95 years (1.5-13 years), with a female to male ratio 1.6. Following BPV, there was a significant decrease in the median peak pulmonary trans-valvular gradient from 106 mmHg to 40 mmHg (p < 0.001). The immediate success rate was 71%, with post-procedural complications at 4.3%. In a median follow-up of 114 months (IQR 72-132 months), 34.1% developed moderate to severe PR, and restenosis occurred in 24.4%. High balloon annulus ratio predicted moderate to severe PR, while dysplastic or complex pulmonary valve, high pre-procedural and immediate post-procedural peak gradients, and high pre-procedural left ventricular systolic pressure predicted restenosis.
Conclusion:
Most patients typically achieve initial success following BPV at our center. However, it is not unusual for moderate to severe pulmonary regurgitation and restenosis to develop during follow-up. As such, this study underscores the significance of thorough follow-up care for patients who underwent BPV to promptly detect and address potential complications.
