[Short and long term results of pulmonary balloon valvuloplasty in children]
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M Beghetti1, I Oberhänsli, B Friedli
1Département de pédiatrie, Hôpital des enfants, Hôpital cantonal universitaire, Genève. beghetti-maurice@diogenes.hcuge.ch
Insights
Percutaneous balloon valvuloplasty offers excellent short- and long-term results for congenital pulmonary valve stenosis. This minimally invasive procedure significantly reduces transvalvular gradients with minimal complications, making it a preferred treatment option.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Congenital pulmonary valve stenosis is a significant condition requiring effective treatment.
- Surgical valvotomy has been the traditional approach, but percutaneous balloon valvuloplasty offers an alternative.
Purpose of the Study:
- To evaluate the short- and long-term efficacy of percutaneous balloon valvuloplasty for congenital pulmonary valve stenosis.
- To assess changes in transvalvular gradient and pulmonary insufficiency post-procedure.
Main Methods:
- A review of 73 percutaneous balloon valvuloplasties performed between 1985 and 1997 in 70 patients.
- Measurement of transvalvular gradients pre- and post-procedure via catheterization and Doppler echocardiography, with follow-up echocardiography.
Main Results:
- Successful valvuloplasty in 61/70 patients; 9 required surgical intervention due to dysplastic valves.
- Immediate gradient reduction of 60% (78.3 to 33.7 mm Hg).
- Long-term follow-up (4.2 years) showed a further gradient decrease to 20 mm Hg, with mild pulmonary insufficiency in most patients. Zero mortality and one complication (endocarditis).
Conclusions:
- Percutaneous balloon valvuloplasty demonstrates excellent short- and long-term outcomes for congenital pulmonary valve stenosis.
- The procedure is a viable and potentially preferred therapeutic option.
- Failure is associated with highly dysplastic valves, necessitating potential surgical management.
Abstract:
Percutaneous balloon valvuloplasty is an alternative to surgical valvotomy for congenital pulmonary valve stenosis. Between 1985 and 1997, 73 valvuloplasties were performed in 70 patients, age range 1 day to 24.7 years. We reviewed the short- and long-term results in regard to transvalvular gradient and pulmonary insufficiency. The gradient was measured pre- and immediately post-valvuloplasty at catheterization and by Doppler echocardiography, and by echocardiography only at follow-up. Valvuloplasty was successful in 61/70 patients whereas surgical valvotomy was necessary in 9/70 because of a very dysplastic valve. A second valvuloplasty was performed in 3 patients presenting with restenosis. A 60% decrease in the gradient was noted immediately after the procedure, from 78.3 +/- 24.5 to 33.7 +/- 19.7 mm Hg (p < 0.05). A follow-up of more than 2 years (4.2 +/- 2.2 years) was obtained in 35 patients. A further decrease in the gradient was noted, to 20 +/- 12 mm Hg, and the degree of pulmonary insufficiency was mild in all patients except 2 with a moderate leak. The mortality was 0% and only 1 patient had a complication (endocarditis). The short- and long-term results of pulmonary percutaneous balloon valvuloplasty are excellent. It can be considered the therapy of choice. The gradient shows a further decrease during follow-up due to regression of the infundibular muscular stenosis. Failure is attributed to very dysplastic valves and these patients may require, in a second stage, a surgical approach (patch enlargement and/or valvulectomy).
