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Balloon pulmonary valvuloplasty in infants and children: technique and immediate result
1Department of Pediatrics, Kaohsiung Medical College, Taiwan, Republic of China.
Insights
Balloon pulmonary valvuloplasty (BPV) effectively treats pulmonary stenosis in children, significantly reducing pressure gradients. This safe procedure is the preferred choice for pediatric patients with this condition.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Pulmonary stenosis is a common congenital heart defect.
- Isolated pulmonary stenosis requires effective treatment to prevent right ventricular dysfunction.
Purpose of the Study:
- To evaluate the efficacy and safety of balloon pulmonary valvuloplasty (BPV) for treating isolated pulmonary stenosis in pediatric patients.
- To assess hemodynamic changes and success rates following BPV.
Main Methods:
- Cardiac catheterization was performed on 20 pediatric patients with moderately severe isolated pulmonary stenosis.
- Balloon pulmonary valvuloplasty (BPV) was conducted, followed by immediate post-procedure hemodynamic assessment.
Main Results:
- BPV significantly reduced right ventricular pressure (89 to 46 mmHg) and the pulmonary valve pressure gradient (68 to 24 mmHg).
- Successful BPV (gradient < 36 mmHg) was achieved in 75% of cases (15/20).
- No significant complications were reported, with favorable outcomes in cases requiring redilatation or surgery.
Conclusions:
- Balloon pulmonary valvuloplasty is an effective and safe interventional procedure for pediatric pulmonary stenosis.
- BPV should be considered the primary treatment of choice for significant pulmonary stenosis in infants and children.
Abstract:
Between 1986 and Feb. 1993, 20 patients with moderately severe isolated pulmonary stenosis underwent cardiac catheterization and balloon pulmonary valvuloplasty (BPV). Their ages ranged from 7 months to 11 years old (mean 6.2 years), their weights ranged from 8 to 45 kg (mean 14.5 kg). Immediately after BPV, the right ventricular pressure decreased from 89 +/- 21 to 46 +/- 16 mmHg (p < 0.005). The pressure gradient across the pulmonary valve reduced by 68%, from 68 +/- 23 to 24 +/- 16 mmHg (p < 0.005). There was no significant changes in both pulmonary artery pressure (19 +/- 4 versus 21 +/- 3 mmHg), and aortic pressure (102 +/- 11 versus 104 +/- 11 mmHg). Successful BPV (pulmonic pressure gradient < 36 mmHg) was achieved in 15 cases (75%). Among the 5 unsuccessful cases, 2 patients underwent redilatation which had excellent results. Another 2 patients received operations, one was a dysplastic pulmonary valve, the other was due to a gradient across the pulmonary valve > 120 mmHg before BPV. The remaining one had only 40 mmHg gradient after BPV, and he was doing well on follow-up. There were no significant complications in these series. BPV is an effective and safe procedure. It should be the treatment of choice for significant pulmonary stenosis in infants and children.