BALLOON PULMONARY VALVULOPLASTY FOR COMPLEX CYANOTIC HEART DEFECTS

Abstract

Six infants with complex cyanotic heart defects (CCHD) (tetralogy of Fallot (TOF) in two, transposition of the great arteries with ventricular septal defect (VSD) and pulmonary stenosis (PS) in two, dextrocardia, ventricular inversion, VSD and PS in the fifth, and critical PS with hypoplastic right ventricle in the sixth), aged 7 days to six months weighing 2.9 to 7.9 kg, underwent percutaneous balloon pulmonary valvuloplasty (PBPV) as a palliative procedure. The indication for PBPV was complex cardiac defect not amenable to total correction at the age and size at presentation but at the same time requiring palliation of pulmonary oligemia. The pulmonary blood flow index (1.83 ± 0.55 vs. 3.07 ± 0.65 1/min/m2, p<0.05), QP:QS (0.55 ± 0.05 vs. 1.0 ± 0.28, p<0.02), and pulmonary artery pressure (21 ± 6 vs. 38 ± 12 mmHg, p<0.5) increased following PBPV. Arterial oxygen saturation increased immediately in TOF and dextrocardia patients while there was no immediate increase in other three; the latter is presumably related to dynamics of interatrial shunting. Immediate surgical intervention was avoided in all six patients. On follow-up 3 to 6 months after PBPV, all infants were thriving well with decreased hypoxemia and polycythemia. Follow-up catheterization data are available in 3 patients, 3 to 6 months following PBPV and in all three, the immediate post PBPV improvement persisted. These data suggest, that PBPV offers an excellent palliation of pulmonary oligemia in CCHD, thus, avoiding the risks of immediate surgical palliation and paving for a better result of eventual total surgical correction.