Significance of infundibular obstruction following balloon valvuloplasty for valvar pulmonic stenosis

Echocardiographic Evaluation of Congenital Cardiopathies Before and After Intervention

“…Delayed gradient reduction is possible with regression of the RVOT hypertrophy and disappearance of postoperative pulmonic valve thickening. This phenomenon has been well documented in human medicine [5,20,21]. A study has shown that the long-term outcome of patients after a PBV depends on the site of the residual gradient pressure: RVOT gradients decreased significantly over time whereas valvular gradients increased slightly [32].…”

“…This complication is the result of ventricular hypercontractility associated with severe RVOT hypertrophy. It is significantly correlated to the transvalvular pressure gradient, the degree of RV hypertrophy, and RVOT hyperactivity [20][21][22][23]. Treatment with an intravenous beta blocker such as esmolol can effectively reduce the contractility of the right ventricle and its RVOT, thus reducing the dynamic component of the obstruction at the outflow tract level.…”

Pulmonary stenosis

“…The complications that may accompany an invasive procedure (eg, significant blood loss, infection), although unlikely, are potential complications. Special points It should be noted that infundibular obstruction sometimes accompanies valvar obstruction but frequently resolves after relief of the valvar lesion [8,15]. Although the recommendation to use a balloon annulus ratio of 1.2:1 to 1.4:1 is made based on reliable data [16][17][18], a recent report [19] suggests that larger balloons (particularly if they are used in neonates) are likely to produce more severe pulmonary insufficiency.…”

Interventional Pediatric Cardiology: State of the Art and Future Directions

“…The causes of restenosis have been identified [68,132], and appropriate modification of the technique, particularly use of a balloon/annulus ratio of 1.2 to 1.4 may produce better results than previously documented. Infundibular obstruction may develop following balloon dilatation; this appears to be more frequent in older subjects and in patients with higher degree of obstruction [190]. However, this can be successfully treated with adequate valvuloplasty and ␤-blocking drugs, with rare need for surgery [130].…”