Abstract
Percutaneous balloon pulmonary valvuloplasty (PBPV) is the treatment of choice for isolated pulmonary valve stenosis. While this procedure is highly efficacious and has an excellent safety profile, as currently practiced, patients are obligatorily exposed to the secondary risks of ionizing radiation and contrast media. To mitigate these risks, we developed a protocol which utilized echo guidance for portions of the procedure which typically require fluoroscopy and/or angiography. Ten cases of echo-guided pulmonary valvuloplasty (EG-PBPV) for isolated pulmonary stenosis in children less than a year of age were compared to a historical cohort of nineteen standard cases using fluoroscopy/angiography alone, which demonstrated equivalent procedural outcomes and safety, while achieving a median reduction in radiation (total dose area product) and contrast load of 80% and 84%, respectively. Our early experience demonstrates that EG-PBPV in neonates and infants has results equivalent to standard valvuloplasty but with less radiation and contrast.
Highlights
Percutaneous balloon pulmonary valvuloplasty (PBPV) is the treatment of choice for infants and neonates with isolated valvar pulmonary stenosis (PS) [1]
All echocardiography-guided PBPV (EG-PBPV) studies were performed by three echocardiographers and two interventionalists
Two patients (20%) in the EG-PBPV group and six patients (32%) in the standard PBPV (S-PBPV) group presented as critical PS
Summary
Percutaneous balloon pulmonary valvuloplasty (PBPV) is the treatment of choice for infants and neonates with isolated valvar pulmonary stenosis (PS) [1]. Exposure to free iodide in contrast media can adversely affect thyroid function, causing transient but clinically significant hypothyroidism [5] These exposure risks can be mitigated with the use of real-time, non-irradiating imaging modalities such as transthoracic and transesophageal echocardiography (TTE and TEE), which have been utilized to assist with device closure of shunt lesions such as atrial septal defects and patent ductus arteriosus, but have played a role in limiting radiation exposure in extremely premature infants as well as pregnant and post-transplant patients [6,7,8,9]
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