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Percutaneous balloon pulmonary valvuloplasty in children: experience at Siriraj Hospital
D Laohaprasitiporn1, A Nana, J Soongsawang
1Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Percutaneous balloon pulmonary valvuloplasty (PBPV) effectively treated children with pulmonary valvar stenosis. This minimally invasive procedure significantly reduced pressure gradients and improved valve annulus size, demonstrating excellent success rates.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Pulmonary valvar stenosis (PVS) is a significant congenital heart defect.
- Percutaneous balloon pulmonary valvuloplasty (PBPV) is a less invasive treatment option.
- Assessing the efficacy and outcomes of PBPV in pediatric patients is crucial.
Purpose of the Study:
- To evaluate the effectiveness of PBPV in children with severe pulmonary valvar stenosis.
- To assess immediate and intermediate outcomes, including pressure gradients and valve annulus size.
- To determine the success rate and complication profile of PBPV.
Main Methods:
- Retrospective study of 27 children with PVS (pressure gradient >= 40 mmHg) undergoing PBPV.
- Echocardiography and cardiac catheterization used for measurements (pulmonary valve annulus, pressure gradient).
- Follow-up assessments at 6 and 12 months post-procedure.
Main Results:
- PBPV significantly reduced right ventricular systolic pressure and pulmonary pressure gradients immediately post-procedure.
- Pulmonary pressure gradients remained significantly reduced at 6-month follow-up.
- Pulmonary valve annulus size significantly increased by 12-month follow-up.
- High success rate (85%) with only minor complications reported.
Conclusions:
- PBPV is an excellent and effective treatment for pediatric pulmonary valvar stenosis.
- The procedure leads to significant hemodynamic improvement and favorable long-term valve remodeling.
- PBPV offers a safe and successful alternative to surgical intervention.
Abstract:
Twenty-seven children with pulmonary valvar stenosis with pressure gradient (PG) > or = 40 mmHg underwent percutaneous balloon pulmonary valvuloplasty (PBPV) at Siriraj Hospital between February 1993 and August 1996. There were 13 males and 14 females, with an age range from 2 months to 14 years, and body weight from 4.7 to 42.1 kg. The majority (92.6%) were asymptomatic. Before the PBPV, the pulmonary valve annulus (PVA) measured by echocardiography was significantly greater than that measured by cardiac catheterization (15.2 +/- 3.7 vs 14.5 +/- 3.9 mm, P = 0.006). However, there was linear association (r = 0.972) between the two methods. The PG obtained by the two methods showed no significant difference (90.8 +/- 35.3 by echocardiography vs 97.3 +/- 47.2 mmHg by catheterization, P = 0.266). Immediately after PBPV, the right ventricular systolic pressure (113.7 +/- 41.1 pre vs 62.3 +/- 28.1 mmHg post) and the PG 103.4 +/- 43.4 pre vs 49.0 +/- 31.1 mmHg post) were significantly reduced (p < or = 0.0005). At 6-mo follow-up echocardiography, the PG was 28.6 +/- 17.6 mmHg and was significantly reduced (P = 0.0005). The PVA significantly increased at the 12 mo follow-up (15.2 +/- 3.6 pre vs 17.6 +/- 3.8 mm post, P = 0.001). Only minor complications were reported in the present study; bleeding (3.7%), transient bradycardia (7.4%) and pulmonary regurgitation not more than moderate severity (79%). The immediate and intermediate results of PBPV are excellent with a success rate of 85 per cent.