28. Critical pulmonary valve stenosis: Medical management beyond balloon dilation

Abstract

Background Neonates with critical pulmonary valve stenosis (PVS) tend to remain oxygen dependentpost successful balloon valvuloplasty. Phentolamine and captopril were observed by us to improve oxygen saturation. Objective Describe the role of phentolamine and captopril in the treatment of these category of patients. Methods In a retrospective cohort study, 28 neonates with critical PVS underwent balloon valvuloplasty. Twenty remained oxygen or/prostaglandin (PGE)-dependent post-interventionand were treated with phentolamine or captopril accordingly. Oxygen saturation was monitored pre and post intervention and following treatment. Results Mean age and weight was 25.2 days and 3.1 kg. Before balloon dilation 18/20 (90%) neonates were on prostaglandin while after the procedure only 6/18 patients required it. A total of 20 patients required oxygen after intervention. Nine patients (45%) werestarted on phentolamine. One with severe infundibular stenosis did not respondfavorably. Eleven patients (55%) were started directly on captopril. After introducing phentolamine or captopril, PGE could be discontinued after a mean time of 15.9 h and mean oxygen saturation increased from 76.7% to 93.0%. Conclusion Phentolamine and/or Captopril have a therapeutic role in neonates with critical PVS who remain oxygen dependent after balloon dilation. Both medicationslead to vasodilatation of pulmonary and systemic vascularity. They facilitate inflowto the right ventricle. Right to left shunt across a PFO or/ ASD minimizesand saturation improves leading to a significantreduction in length of hospitalization.