Supravalvular and Valvular Pulmonary Stenosis: Predictive Features and Responsiveness to Percutaneous Dilation

Poupart, Steffany; Navarro-Castellanos, Iñaki; Raboisson, Marie‐Josée; Lapierre, Chantale; Déry, Johanne; Miró, Joaquim; Dahdah, Nagib

doi:10.1007/s00246-021-02545-w

Cited by 6 publications

(11 citation statements)

References 12 publications

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“…In patients with residual PS, secondary BVP was the treatment of choice for valvular PS and was successful, but in patients with combined valvular and supravalvular restenosis, surgery was performed, as recommended by the AHA [16,22]. While the efficacy of BVP in children with isolated valvular PS is excellent, pulmonary BVP has limitations in children with a combined valvular and supravalvular PS [21], attributing to the high number of additional procedures needed in our cohort (Table 1). The number of additional supravalvular PS was high (21.7%), requiring more aggressive procedural BVP, but with a comparable low number of complications and good success rate of BVP (23 of 31 patients, 74%).…”

Section: Discussionmentioning

confidence: 99%

“…The number of additional supravalvular PS was high (21.7%), requiring more aggressive procedural BVP, but with a comparable low number of complications and good success rate of BVP (23 of 31 patients, 74%). Nevertheless, supravalvular PS has been described as risk factor for procedural failure [13,21] and its absence as a significant predictor of success [28]. Surgery is mentioned as the recommended first line therapy for supravalvular PS [16,22], because only few studies report successful BVP in these patients [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, supravalvular PS has been described as risk factor for procedural failure [13,21] and its absence as a significant predictor of success [28]. Surgery is mentioned as the recommended first line therapy for supravalvular PS [16,22], because only few studies report successful BVP in these patients [19][20][21]. The elastic recoil properties of the supravalvular ridge were discussed as one possible contributing factor to the failure of BVP in patients with supravalvular PS [18].…”

Section: Discussionmentioning

confidence: 99%

“…Our findings are comparable to a recently published trial where the reintervention rate was 32% in patients with supravalvular PS. Poupart et al [21] A higher balloon-to-PV annulus up to 1.4 can be used without a higher rate of complications (Table 1). Of note, the number of PR is lower in patients with combined valvular and supravalvular PS, which underlines the more relevant aspect of the supravalvular PS (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the combination of valvular and supravalvular PS may also be associated with general hypoplasia of central and peripheral pulmonary arteries, often found in patients with genetic syndromes such as Allagile syndrome and Williams syndrome [14,15]. Controversy exists in literature about the preferred treatment for supravalvular PS, which can be either treated by surgery [16][17][18], or by balloon angioplasty of the main pulmonary artery [19][20][21]. Numbers of pediatric studies on treatment of combined valvular and supravalvular PS are limited.…”

Section: Introductionmentioning

confidence: 99%

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Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Lenoir¹,

Quandt²,

Kretschmar³

et al. 2022

Congenital Heart Disease

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Objectives: Factors influencing results of balloon valvuloplasty (BVP) of pulmonary valve stenosis (PS) in children are investigated. Background: BVP has become the standard of care for PS, medium-term results are not uniform and depend on various preconditions. Methods: We analysed the medium-term results of BVP of PS in children in an observational, single centre study. Need for additional procedure was defined as outcome after initial BVP. Results: We included 143 children (83 female) at a median (IQR) age of 2.6 (0.26-9.24) months and body weight of 5 (3.4-8) kg at BVP with a follow-up of 5.04 (1.6-10.2) years. We used balloon size of 10 (9-14) mm and maximal balloon pressure of 4 (3.5-10) atm, resulting in balloon-to-pulmonary annulus ratio of 1.28 (1.2-1.4). Systolic pressure gradient of PS was reduced with BVP (43.5 mmHg vs. 14.0 mmHg, p < 0.001) and confirmed by echocardiography (68.0 mmHg vs. 25.0 mmHg, p < 0.001) day 1 post procedure. Pulmonary BVP with associated supravalvular PS resulted in a relevant reduction of systolic pressure gradient in 23 of 31 patients (74.2%). Early additional procedure was necessary in 14 patients (9.8%) after 0.2 (0.1-0.7) years due to residual PS (n = 13) and infective endocarditis (n = 1). Factors for additional procedures were associated supravalvular PS with a higher residual pressure gradient, but not genetic syndrome. During further follow-up of 5.04 (1.6-10.2) years no further additional procedures were needed. Conclusions: Pulmonary BVP of native pulmonary valve stenosis leads to excellent medium-term results, even in 3 of 4 infants with associated supravalvular obstruction sufficient pressure relief can be obtained.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Lenoir¹,

Quandt²,

Kretschmar³

et al. 2022

Congenital Heart Disease

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Supravalvular pulmonary stenosis: A risk factor for reintervention in Noonan syndrome with pulmonary valve stenosis

Abumehdi

Mehta

Afifi

et al. 2022

Cathet Cardio Intervent

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Objectives: To assess the short-and long-term outcomes of balloon pulmonary valvuloplasty (BPV) in children with Noonan syndrome (NS).Background: Pulmonary stenosis (PS) is the most common congenital heart lesion in NS. BPV is the accepted first line treatment in PS. However, BPV in NS patients has been reported to be less effective, without specific factors for the need for reintervention being identified.Methods: Retrospective case-note review of all patients with NS who underwent BPV between 1985 and 2020. Patients were divided into 2 groups: those with supravalvular pulmonary stenosis (SPS) in addition to valvar PS, and those with isolated valvar PS.Results: A cohort of 54 patients with NS underwent BPV at a median of 275 (interquartile range [IQR]: 108-575) days of age. SPS was present in 32 (59%) patients whereas 22 had (41) isolated PS. The preprocedural invasive gradient was 47 (IQR: 35-69) mmHg, and 44 (IQR: 35-48) mmHg in those with SPS and those without respectively (p = 0.88). Reintervention was required in 22 patients (41%): 17 (77%) with SPS and 5 (23%) without (p = 0.017). Fourteen patients (11 with SPS) required surgical reintervention and 8 (6 with SPS) required further BPV. There was no significant difference in the age at initial BPV, pre-and postprocedural gradients and interval until reintervention between groups.Conclusion: This is the largest reported cohort of patients with NS undergoing BPV.Although BPV is often successful, the reintervention rates are high. SPS was a risk factor for reintervention.

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Advances in the Treatment of Pulmonary Valve Stenosis

Scansen

2023

Veterinary Clinics of North America: Small Animal Practice

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Supravalvular and Valvular Pulmonary Stenosis: Predictive Features and Responsiveness to Percutaneous Dilation

Cited by 6 publications

References 12 publications

Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Supravalvular pulmonary stenosis: A risk factor for reintervention in Noonan syndrome with pulmonary valve stenosis

Advances in the Treatment of Pulmonary Valve Stenosis

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