Balloon pulmonary valvuloplasty: Results of the Valvuloplasty and Angioplasty of Congenital Anomalies Registry

Abstract

Eight hundred twenty-two balloon pulmonary valvuloplasties were reported to the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Before and after systolic outflow gradients were recorded in 784 valvuloplasties, and the gradient decreased from 71 +/- 33 to 28 +/- 21 mm Hg. The sites of residual obstructions could be ascertained in 196 patients. In these, the total systolic outflow gradients decreased from 85 +/- 41 mm Hg to 33 +/- 27 mm Hg. Of this total residual gradient, 16 +/- 15 mm Hg was transvalvar and 18 +/- 24 mm Hg was infundibular. The degree to which infundibular obstruction subsequently resolved was not determined in this study. The procedure was less effective in reducing outflow gradients in patients with dysplastic valves with or without Noonan's syndrome. There were 5 major complications (0.6%), including 2 deaths (0.2%), a cardiac perforation with tamponade (0.1%) and 2 tricuspid insufficiencies (0.2%). There were 11 minor complications (1.3%) and 21 incidents (2.6%). The incidence of major complications, minor complications and incidents was inversely related to age; it was substantially higher in infants and, in particular, neonates. Balloon pulmonary valvuloplasty is a safe and effective method of lowering pulmonary outflow gradients in infants, children and adults. Small transvalvar and varied infundibular gradients commonly are present at the end of the procedure. Assessing the full effect of the procedure requires intermediate-term follow-up and assessing the duration of relief requires long-term follow-up.

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…405 Several studies have been reported that compared balloon valvotomy with matched surgical control patients. 392,406,407 In 1 study, 406 gradients were slightly but statistically higher in the post-balloon valvotomy group than in the surgical cohort (24 plus or minus 2.7 versus 16 plus or minus 1.5 mm Hg). Pulmonary regurgitation, however, was absent (55%) or mild (45%) in the valvuloplasty group yet at least mild (45%) or moderate (45%) in the surgical cohort.…”

“…390 The treatment of significant PS is either by percutaneous balloon valvuloplasty or by surgical intervention. 392 The procedure is usually performed from the right femoral vein. Because of the elasticity of the pulmonary annulus, it has been found that oversizing the balloons up to 1.4 times the measured pulmonary annulus is more effective in achieving a successful result (usually defined by a final valvular gradient of less than 20 mm Hg).…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…A nonsurgical approach with balloon valvotomy was described in 1982 840 and by the late 1980s had become the procedure of choice in the United States for the typically domed, thickened valve, both for children 841 and adults. 842,843 Surgery is still usually required for the dysplastic valve often seen in Noonan's syndrome.…”

Pediatric Therapeutic Cardiac Catheterization

“…Complications are rare; pulmonary regurgitation may occur in some patients but is typically mild and inconsequential. 131 Balloon dilation remains the treatment of choice for pulmonary valve stenosis. The indications for pulmonary valve balloon dilation should be essentially the same as those for surgical pulmonary valvotomy.…”