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Results of pulmonary balloon valvuloplasty persist and improve at late follow-up in isolated pulmonary valve stenosis

Published online by Cambridge University Press:  27 June 2017

John J. Parent ,
Michael M. Ross ,
Edgard A. Bendaly  and
John P. Breinholt
John J. Parent*
Affiliation:
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
Michael M. Ross
Affiliation:
Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
Edgard A. Bendaly
Affiliation:
Department of Pediatrics, Sanford School of Medicine, Sioux Falls, South Dakota, United States of America
John P. Breinholt
Affiliation:
Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
*
Correspondence to: J. J. Parent, MD, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, RR 127, Indianapolis, IN 46022, United States of America. Tel: 317 274 3343; Fax: 317 274 4022; E-mail: jjparent@iu.edu
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Abstract

Background

Pulmonary balloon valvuloplasty is a safe and effective treatment for children with pulmonary valve stenosis. A few studies evaluate the long-term outcomes of the procedure, particularly the degree of pulmonary regurgitation. We evaluated the outcomes of children >1 year following valvuloplasty for pulmonary valve stenosis.

Methods

A retrospective analysis of children with pulmonary valve stenosis following pulmonary balloon valvuloplasty at a single institution was performed. Clinic summaries, catheterisation data, and echocardiographic data were reviewed. Inclusion criteria were isolated pulmonary valve stenosis, age <19 years at the time of intervention, and at least one echocardiogram performed at least 1 year after valvuloplasty.

Results

A total of 53 patients met inclusion criteria. The median age at valvuloplasty was 0.4 years (0.01–10.6 years). The last follow-up was 4.8±2.3 years following valvuloplasty. The pre-valvuloplasty peak instantaneous gradient by echocardiography was 60.6±14.6 mmHg. The peak gradient at the first postoperative echocardiography was reduced to 25.5±12 mmHg (p<0.001), and further decreased to 14.8±15.8 mmHg (p<0.001) at the most recent follow-up. The degree of regurgitation increased from before valvuloplasty to after valvuloplasty (p<0.001) but did not progress at the most recent follow-up (p=0.17). Only three patients (5.7%) required re-intervention for increasing pulmonary stenosis (two surgical; one repeat balloon). No significant procedural complications occurred.

Conclusions

Pulmonary balloon valvuloplasty remains a safe and effective treatment for children with isolated pulmonary valve stenosis, with excellent long-term outcomes and no mortality. A few patients require further intervention. Long-term follow-up demonstrates decreased, residual stenosis. Patients have a small, acute increase in pulmonary regurgitation following valvuloplasty, but no long-term progression.

Keywords

Pulmonary stenosispulmonary valve stenosispulmonary regurgitationvalvuloplastyballoon valvuloplasty
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1566 - 1570
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Copyright
© Cambridge University Press 2017 

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