Balloon Valvuloplasty and Angioplasty in Pediatric Practice

Abstract

Congenital heart defect (CHD) is the most common congenital anomaly in children and constitutes approximately 1% of live births. This will result in nearly 35,000 babies born with heart defects in the USA alone. Nearly 50% of these babies can be managed with simple medications, observation and follow-up without any major therapeutic intervention. However, the remaining 50%, in the past, required surgical, some under cardiopulmonary bypass, intervention. Since the advent of transcatheter techniques, 50% of these babies can be managed with less invasive, percutaneous, transcatheter techniques. In this editorial the role of balloon valvuloplasty and angioplasty in the management of children with CHDs will be reviewed.In early 1950s, Rubio-Alverez and Limon-Lason used a modified ureteral catheter to perform transcatheter pulmonary and tricuspid valvotomy. A decade later, Dotter and Judkins utilized a gradational transcatheter dilatation technique to open stenotic and occluded peripheral arteries. In mid to late 1970s, Gruntzig and his colleagues extended Dotter and Judkins' technique and successfully dilated stenotic lesions of the iliac, femoral, popliteal, renal and coronary arteries; they utilized a double-lumen catheter with a non-elastic balloon that they developed. Balloon dilatation techniques were then extended to relieve obstructive lesions of the aorta,pulmonary valve, aortic valve, mitral valve,subaortic membrane, branch pulmonary artery stenosis, stenoticbioprosthetic valves and other obstructive vascular lesions. Extensive review of the techniques and results may be found in our previous publications on this subject [1][2][3][4][5][6][7][8]. Pulmonary stenosisValvar pulmonary stenosis, initially described by Kan and her associates [9], is the first CHD for which balloon valvuloplasty is acknowledged as a therapeutic procedure of choice. The indications for catheter intervention are the same as those used for surgical valvotomy: a moderate degree of pulmonary valve stenosis with a peak-to-peak gradient >50 mmHg with normal cardiac index. Initially recommended size of the balloon is 1.2 to 1.4 times that of pulmonary valve annulus. Relief of pulmonary valve obstruction by balloon valvuloplasty is documented in neonates, infants, children and adults. Immediate and short-term results are available but, there are limited long-term follow-up data [7]. Doppler echocardiographic evaluation at followup is reflective of the results without the necessity for repeat cardiac catheterization. Recent studies suggested pulmonary insufficiency as potential problem [7,10,11]. It appears that use of large non-compliant balloons may be associated with pulmonary insufficiency [11]. Consequently the revised recommendations are to achieve balloon/ annulus ratios of 1.2 to 1.25 [12,13]. Balloon pulmonary valvuloplasty is an excellent and preferred alternative to open or closed heart surgery in the treatment of pulmonary stenosis in patients of all age groups. Long-term follow-up evaluation of pulmonary insufficiency is require...

Transthoracic Vector Flow Imaging in Pediatric Patients with Valvular Stenosis – A Proof of Concept Study

“…Balloon valvotomy was performed using compliant balloons (Tyshak, Numed Inc., Hopkinton, NY, USA) with a diameter according to the standard guidelines (100 –130% of annular diameter for pulmonary and 80 –100% in aortic valves) 13 . Post-valvotomy angiography checked for the absence of rupture and valve regurgitation followed by post-procedural pressure measurement in the aorta/pulmonary artery and in the left/right ventricle.…”

“…Balloon valvotomy was performed using compliant balloons (Tyshak, Numed Inc., Hopkinton, NY, USA) with a diameter according to the standard guidelines (100 -130 % of annular diameter for pulmonary and 80 -100 % in aortic valves) [13]. Post-valvotomy angi-…”