[Balloon dilatation of valvular pulmonary stenoses in adults]

Balloon valvuloplasty of pulmonary stenosis has become the treatment of choice in children and adults. This is a report about the long term results in adult patients. Forty-six patients (mean age 37 +/- 17 years) with pulmonary stenosis were treated between 1984 and 1994 by this method. Thirty-four of 46 patients were re-examined 3 months to 9 years (mean 3.4 years) later by right heart catheterization and echocardiography. These 34 patients were representative for the whole group concerning age, severity of the pulmonary stenosis, and acute results after the intervention. The pressure gradient was acutely reduced by balloon valvuloplasty from 86 +/- 35 to 38 +/- 17 mm Hg (p < 0.0001) (n = 46) and was 32 +/- 10 mm Hg (n.s.) (n = 34) at follow-up. Within 3 months after the intervention, 8 of 13 patients with a pressure gradient > or = 100 mm Hg, showed spontaneously further reduction of the gradient due to the resolution of the subvalvular muscular hypertrophy. During a bicycle exercise test with 9 patients, the gradient rose significantly from 29 +/- 10 to 53 +/- 23 mm Hg (p < 0.01) as determined by right heart catheterization. All of these patients had normal cardiac output at rest and during exercise. None had signs of right ventricular hypertrophy in the electro- or echocardiogram. It is concluded that balloon valvuloplasty of pulmonary stenosis is the first line treatment in adults.