Balloon pulmonary valvuloplasty in the management of cyanotic congenital heart defects

Abstract

Twenty-three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 +/- 8% (mean +/- SD) vs. 94 +/- 5%, P less than 0.001] and pulmonary-to-systemic flow ratio (0.7 +/- 0.1 vs. 1.0 +/- 0.2, P less than 0.001). Peak systolic pressure gradient across the pulmonary valve decreased (P less than 0.001) from 105 +/- 48 to 25 +/- 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 +/- 13 vs. 83 +/- 13%, P less than 0.01) and pulmonary-to-systemic flow ratio (0.7 +/- 0.4 vs. 1.2 +/- 0.5, P less than 0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pulmonic valve (52 +/- 16 vs. 32 +/- 22 mm Hg, P less than 0.05) decreased while infundibular and total pulmonary outflow tract gradients were unchanged (P greater than 0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow-up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary-to-systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease

“…These procedures may cause hypercyanotic episodes, but in some rare situations, they may be a reasonable option for palliation. 94,95 Balloon dilation is not useful for treatment of infundibular pulmonary stenosis unassociated with pulmonary valve stenosis.…”

“…Ezek a beavatkozások cianotikus rohamokat válthatnak ki, azonban ritka esetben a palliatív műtét ésszerű alternatíváját képezhetik. 94,95 A ballonos tágítás nem alkalmas a valvularis pulmonalis stenosissal társuló infundibularis pulmonalis stenosis kezelésére.…”

Interventional Pediatric Cardiology: State of the Art and Future Directions

“…We and others [11,96,98,118] have utilized balloon pulmonary valvuloplasty to successfully relieve pulmonary oligemia and systemic arterial hypoxemia. Increase in the size of the pulmonary arteries and of the left atrium/ventricle at follow-up occurred [87,109,118,141,183] such that patients with previously uncorrectable defects became good risk candidates for surgical correction. Not all cyanotic heart defect patients with pulmonary stenosis are candidates for balloon pulmonary valvuloplasty.…”

Interventional cardiac catheterization

“…Once perforated, the valve is balloon dilated to create unobstructed continuity between the right ventricle and pulmonary artery. Additionally, in patients with tetralogy of Fallot and some additional forms of cyanotic heart disease, balloon pulmonary valvuloplasty has been shown to improve oxygenation, growth of the pulmonary arteries, and right ventricular outflow tract avoiding the need of a systemic-pulmonary shunt as intermediate palliation (92,118,125,161,163).…”