Balloon dilatation in infants and children with dysplastic pulmonary valves: Short-term and intermediate-term results

Abstract

This study was designed to document the results of balloon valvuloplasty in patients with dysplastic pulmonary valves and to determine whether dysplastic pulmonary valves are responsible for recurrence of stenosis after balloon pulmonary valvuloplasty. Balloon valvuloplasty in 13 patients, aged 6 days to 12 years (median 1 year), with dysplastic pulmonary valves reduced the pulmonary valve gradient from 77.2 ± 44.2 (mean ± SD) to 26.8 ± 17.0 mm Hg ( p < 0.001), which remained improved (34.9 ± 34.6 mm Hg; p < 0.02) at 6 to 19 months' (mean 10 months) follow-up. Valvuloplasty in 43 patients without dysplastic pulmonary valves reduced the valvar gradient from 94.3 ± 41.0 to 31.1 ± 22.4 mm Hg ( p < 0.001) immediately after the procedure, which at 6 to 34 months' follow-up in 23 patients was 29.2 ± 33.5 mm Hg ( p < 0.001). The right ventricular peak systolic pressures (96.2 ± 43.3 vs 112.1 ± 40.1 mm Hg) and pulmonary valvar gradients (77.2 ± 44.2 vs 94.3 ± 41.0 mm Hg) before valvuloplasty, residual right ventricular pressures (52.9 ± 14.5 vs 56.1 ± 24.2 mm Hg) and pulmonary valvar gradients (26.8 ± 17.0 vs 31.1 ± 22.4 mm Hg) immediately after vaivuloplasty, and residual right ventricular pressures (59.3 ± 30.3 vs 53.6 ± 34.3 mm Hg) and pulmonary valvar gradients (34.9 ± 34.6 vs 29.2 ± 33.5 mm Hg) at follow-up catheterization were similar ( p > 0.1) in both groups. However, the balloon/anulus ratio used in dysplastic pulmonary valves (1.3 ± 0.25) was insignificantly ( p > 0.1) higher than that used in nondysplastic pulmonary valves (1.2 ± 0.24). Two of the 13 patients with dysplastic valves and 3 of the 23 patients without dysplastic valves required repeat valvuloplasty ( p > 0.1) at follow-up. Residual valvar gradients in excess of 30 mm Hg at follow-up were present in 3 of 13 and 4 of 23 ( p > 0.1) patients, respectively, with and without dysplastic valves. When all valvuloplasties were divided into those with good results at follow-up (gradient ≤ 30 mm Hg; 29 patients) and those with poor results (gradient >30 mm Hg; 7 patients), the prevalence of dysplastic pulmonary valves, respectively, in these two groups was 10 and 3, and was similar ( p > 0.1). In 10 patients with dysplastic valves with good results, the balloon/anulus ratio (1.37 ± 0.22) used for valvuloplasty was larger ( p < 0.01) than that (1.04 ± 0.17) used in three patients with poor results. These data suggest that the results of balloon valvuloplasty in patients with dysplastic valves are comparable to those without, that the dysplastic valves were not responsible for recurrence of valve stenosis, and that use of large balloons in patients with dysplastic pulmonary valves may have reduced the chance for recurrence.