Management of typical and dysplastic pulmonic stenosis, uncomplicated or associated with complex intracardiac defects, in juveniles and adults: Use of percutaneous balloon pulmonary valvuloplasty with eight‐month hemodynamic follow‐up

Abstract

To alleviate large fixed right ventricular (RV) outflow gradients, percutaneous balloon dilatation of pulmonic stenosis (PS) was performed in 38 patients with mean age of 14 +/- 14 years (median: 9 years, age range: 9 months to 63 years). There were 21 males and 17 females. Thirty-four patients had typical PS (5 of them also having other complex congenital cardiac anomalies, while 13 additional patients had a patent foramen ovale); 2 further subjects had subpulmonic, and 2 dysplastic pulmonary valvular obstructions. Sixteen patients were in the New York Heart Association (NYHA) Class I, 15 in Class II, 6 in Class III, and 1 in Class IV. Electrocardiographic (ECG) evidence of right ventricular hypertrophy (RVH) was present in 29 patients (76%); 3 patients had right bundle branch block (RBBB). For the entire group, there was a marked decrease in the mean systolic transpulmonic gradient in the immediate post-valvuloplasty period (from 97 +/- 43 to 26 +/- 17 mmHg; P < 0.0001). One patient expired 8 hours post-valvuloplasty (he was in the NYHA Class IV, and had severe RV failure). No other cardiovascular complications were encountered; the median hospital stay was 3 days (range: 1-10 days). At an 8-month follow-up, 12 patients who were reevaluated invasively had a median transpulmonic gradient of 27 mmHg (range: 5-92 mmHg) as compared to their pre-valvuloplasty values of 84 mmHg (range: 49-142 mmHg; P < 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic rounds series II: Pulmonic balloon valvuloplasty

“…The mobility of a dysplastic pulmonary valve is so impaired that surgery is most often the preferred treatment of choice. However, some patients with dysplastic valves may still do well with pulmonary catheter balloon valvuloplasty [5]. Chen et al [4] reported on their results using the Inoue technique in adults and adolescents.…”

“…Unique to pulmonic stenosis is the situation of the dysplastic valve associated with complex intracardiac defects. David et al [5] reported on the results of percutaneous balloon dilatation for pulmonic stenosis in 38 patients ranging from 9 months to 63 years in age. Thirty-four patients had typical pulmonary stenosis, with 5 having complex congenital cardiac anomalies.…”

“…The successful results of balloon techniques have changed clinical practice so that the method of choice for pulmonic stenosis is catheter balloon valvuloplasty over the surgical valvotomy technique, except in patients with dysplastic valves [5]. The mobility of a dysplastic pulmonary valve is so impaired that surgery is most often the preferred treatment of choice.…”

Right-Sided Valve Disease Deserves a Little More Respect

“…42 PBV is the procedure of choice for children and adults with severe or symptomatic PS and carries a low risk of morbidity, mortality, and restenosis. 14,[43][44][45][46][47][48] However, a high frequency of PR has been reported; after PBV, 57% of children had moderate or severe PR at the last follow-up. 49 These data emphasize the need for lifelong follow-up after PBV.…”