Results of balloon valvuloplasty in typical and dysplastic pulmonary valve stenosis: Doppler echocardiographic follow-up

Abstract

To assess the usefulness of balloon valvuloplasty in patients with a dysplastic pulmonary valve, the files of 36 patients (aged 1 day to 18.5 years) who had two-dimensional echocardiography before and continuous wave Doppler echocardiography late after balloon valvuloplasty (balloon diameter greater than or equal to 20% anulus diameter) were reviewed. Results of relief of pulmonary stenosis were graded by catheter gradient in the catheterization laboratory and compared with Doppler echocardiographic findings at follow-up. There were 32 patients with typical pulmonary stenosis and 4 with a dysplastic valve. In the 32 patients with typical pulmonary stenosis, transvalvular gradient changed from a mean of 67 +/- 32 to 20 +/- 20 mm Hg (p less than 0.0001, mean reduction 72.6%). The gradients at follow-up by Doppler echocardiography averaged 20 mm Hg including 15 that increased, 3 that were unchanged and 14 that decreased. Only 3 (9%) of 32 patients had a gradient greater than 25 mm Hg at follow-up and only one gradient was greater than 35 mm Hg. All four patients with a dysplastic valve had a gradient that decreased with valvuloplasty from a mean of 85 +/- 33 to 33 +/- 20 mm Hg (p less than 0.05); gradient reduction in this group ranged from 40 to 85% (mean 57.5%). The gradient at follow-up increased in three of these four patients and decreased in one (the only late gradient less than 25 mm Hg). Late gradient was less than 35 mm Hg in two of the four patients and was reduced by 43 and 57%, respectively, in the other two.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…Its use in patients with a dysplastic valve is much less established, although several authors have suggested situations wherein it may be feasible. 408,409 Postoperative valvular, conduit, or homograft stenosis contributes to the causes of clinical RVOT obstruction, with valvular degeneration expected after approximately 10 to 12 years. 410 There are some data showing that porcine valves may outlast homografts in children.…”

Pediatric Therapeutic Cardiac Catheterization

“…12,13 Some guidelines regarding which valves may be more or less favorable for balloon dilation in pulmonary valve dysplasia have been suggested by a number of authors. [133][134][135] Balloon pulmonary valve dilation has been used successfully in patients with tetralogy of Fallot and other forms of cyanotic heart disease in which valvular pulmonic stenosis is an important feature. Although there appears to be some additional risk involved with using these procedures due to the potential of initiating hypercyanotic episodes, the overall results are encouraging.…”

The diagnosis and treatment of pulmonary valve stenosis in children

“…17 Long-term follow-up showed that; 6 months of postoperative, the systolic pressure gradient across the pulmonary valve stabilized; 20 right ventricular hypertrophy and right ventricular enlargement gradually reduced; Generally PBPV postoperative 6 to 12 months, right ventricular diastolic function returns to normal, 19 long-term effectiveness was same in comparison with surgical operation. 21 Overall, the hospital stay, postoperative ICU monitoring time, the average operation time-consuming and postoperative complications and mortality, etc of PBPV are significantly lower than the surgery.…”