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[Pulmonary valvuloplasty in childhood: the immediate results and long-term follow-up]
G Santoro1, R Formigari, L Pasquini
1Ospedale Bambino Gesù, Roma.
Insights
Pulmonary balloon valvuloplasty effectively treats pulmonary valve stenosis in children, showing excellent long-term outcomes. Conditions like valvular dysplasia can impact success, but overall, the procedure offers a positive prognosis.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary valve stenosis is a common congenital heart defect.
- Pulmonary balloon valvuloplasty is the primary treatment for this condition.
- Limited data exists on long-term outcomes in large pediatric populations.
Purpose of the Study:
- To evaluate the early and long-term efficacy of pulmonary balloon valvuloplasty.
- To analyze factors influencing procedural success and restenosis.
- To assess the long-term prognosis in pediatric patients.
Main Methods:
- A retrospective analysis of 202 procedures in 197 pediatric patients (1984-1994).
- Hemodynamic data, valvular morphology, and patient age were analyzed.
- Clinical and instrumental data were collected during a mean follow-up of 50 months.
Main Results:
- Successful reduction in right ventricular pressure (86 to 41 mm Hg) and transvalvular gradient (67 to 24 mm Hg).
- Overall success rate of 95%; freedom from restenosis was 96% at 5-10 years.
- Valvular dysplasia/annulus hypoplasia correlated with higher restenosis rates (18.8% vs 2.7%).
Conclusions:
- Pulmonary balloon valvuloplasty is a safe and effective treatment for isolated pulmonary valve stenosis in children.
- Valvular dysplasia and annulus hypoplasia are key predictors of restenosis.
- The long-term prognosis for most children after successful valvuloplasty is excellent.
Background:
Pulmonary balloon valvuloplasty is the treatment of choice of pulmonary valve stenosis, but early results and long-term follow-up in a numerous and homogeneous pediatric population are poorly known.
Material And Methods:
From April 1984 to April 1994, 202 valvuloplastic procedures were performed in 197 patients (age 52.5 +/- 150 months). Hemodynamic data were analysed according with valvular morphology and patient's age at procedure. During a follow-up period of 50 +/- 38 months, clinical and instrumental data were collected.
Results:
After pulmonary valvuloplasty RV pressure decreased from 86 +/- 28 to 41 +/- 21 mm Hg (p < 0.001), transvalvular pressure gradient from 67 +/- 27 to 24 +/- 14 mm Hg (p < 0.001) and RV/LV pressure ratio from 1.01 +/- 0.29 to 0.53 +/- 0.19 (p < 0.001). Overall success rate was 95% (187/197 patients). Pulmonary valve dysplasia and/or annulus hypoplasia significantly influenced the efficacy of the procedure and/or the recurrence of valvar stenosis (18.8% vs 2.7%, p < 0.01). During the follow-up period, clinical examination was unremarkable, and transvalvular pressure gradient did not change (23 +/- 9 vs 24 +/- 6 mm Hg at discharge, p = NS). Freedom from restenosis was 98% at 3 years and 96% at 5 and 10 years.
Conclusions:
Pulmonary balloon valvuloplasty is a safe, effective and possibly definitive treatment for isolated pulmonary valve stenosis in infants and children. Age at valvuloplasty does not influence the success of the procedure, as opposed to valvular dysplasia and/or annulus hypoplasia that positively relate to the need of surgical valvotomy and/or the recurrence of stenosis during a long-term follow-up. In conclusion, prognosis of the majority of infants and children after a successful valvuloplasty is excellent during a long-term follow-up period.