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[Intermediate and long-term outcome after percutaneous balloon dilatation of valvular pulmonary stenoses in
Insights
Percutaneous balloon valvuloplasty effectively treats pulmonary valve stenosis in children, significantly reducing right ventricular outflow tract gradients. This safe procedure offers lasting benefits for pediatric patients with this condition.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Context:
- Pulmonary valve stenosis (PVS) is a significant congenital heart defect in children.
- Balloon valvuloplasty offers a less invasive alternative to surgery for PVS.
- Assessing the long-term efficacy and safety of percutaneous balloon valvuloplasty in pediatric PVS is crucial.
Purpose:
- To evaluate the effectiveness and safety of percutaneous balloon valvuloplasty in pediatric patients with pulmonary valve stenosis.
- To assess the immediate and long-term outcomes, including pressure gradients and need for reintervention.
- To determine the impact of pulmonary regurgitation post-procedure.
Summary:
- Fifty-two pediatric patients (7 days to 19 years) underwent pulmonary balloon valvuloplasty.
- Significant reduction in right ventricular outflow tract (RVOT) systolic pressure gradient was observed immediately post-procedure (79.9 to 37.2 mm Hg).
- Long-term follow-up (mean 4.3 years) showed sustained gradient reduction (25.7 to 18.0 mm Hg), with pulmonary regurgitation being hemodynamically insignificant.
Impact:
- Percutaneous balloon valvuloplasty is a safe and effective treatment for pediatric pulmonary valve stenosis.
- The procedure demonstrates lasting efficacy, reducing the need for further interventions.
- This minimally invasive approach provides significant clinical improvement and confirms its value in managing pediatric PVS.
Abstract:
Pulmonary balloon valvuloplasty was performed in 52 patients aged 7 days to 19 years (mean 5.5 years). Mean balloon/anulus ratio was 1.24. Mean right ventricular outflow tract (RVOT) systolic pressure gradient was 79.9 +/- 37.3 (x +/- SD) mm Hg before valvuloplasty and 37.2 +/- 29.6 mm Hg (p < 0.001) immediately after the procedure. 33 patients had residual RVOT-gradient < or = 36 (22 +/- 7) mm Hg, 19 patients had gradients > 36 (67.1 +/- 35.6) mm Hg. During intermediate follow-up (< 2 years) RVOT gradient assessed by catheterization or Doppler echocardiography improved without any additional intervention in 10/19 patients with RVOT gradient > 36 mm Hg early after valvuloplasty. 6/19 patients required additional reduction of RVOT gradient by repeated valvuloplasty (51 +/- 19 to 29 +/- 5 mm Hg; p < 0.01). 3/19 patients needed surgical resection of extremely thickened dysplastic valves. 49 patients had a mid- to long-term follow-up by echocardiography (mean 4.3, max. 9 years); the RVOT gradient decreased from 25.7 +/- 12.8 mm Hg during intermediate follow-up to 18.0 +/- 7.0 mm Hg during long-term follow-up. If pulmonary regurgitation was present after dilatation (n = 38), it was hemodynamically not significant and did not change during follow-up. Percutaneous balloon valvuloplasty was a safe and effective treatment for pulmonary valve stenosis in infancy and childhood. Long-term results confirm the value of this method.