Effects of aortic and pulmonary balloon valvuloplasty on systolic and diastolic cardiac function in children--echocardiographic evaluation.

Abstract

Echocardiography (ECHO) was used to assess the systolic and diastolic cardiac function before and after balloon valvuloplasty (BV) in children with congenital valvular aortic stenosis (AS) or congenital valvular pulmonary stenosis (PS), as compared to age-matched control subjects. BV was performed on each of 7 patients with AS and 9 patients (one patient twice) with PS. BV was effective in all patients. In the AS group the left ventricular outflow pressure gradient was significantly decreased from 67 +/- 16 to 29 +/- 15 mmHg (p < 0.01), and in the PS group the right ventricular outflow pressure gradient was significantly decreased from 64 +/- 21 to 31 +/- 16 mmHg (p < 0.01). To evaluate the systolic function, M-mode ECHO was employed. Before BV, both the AS and PS groups had a higher ejection fraction (EF) and smaller left ventricular (LV) dimension than the control group. Also, before BV, the AS group had severe LV hypertrophy, and the PS group had thick right ventricular wall (RVW) and thick intraventricular septum (IVS). These abnormalities were not significantly changed immediately after BV or in the short term after BV, though they became normalized later, in the intermediate term after BV. To evaluate the diastolic function, the ventricular inflow pattern was assessed using pulsed Doppler ECHO. Before BV, despite the LV hypertrophy in the AS group, the LV inflow indices were similar to those of the control group. During the follow-up period after BV, the LV inflow indices of the AS group did not change. On the other hand, before BV, both the RV and LV inflows of patients with PS had abnormal diastolic filling patterns with decreased filling volumes during early diastole and increased filling volumes during atrial contraction. Immediately after and in the short term after BV, there were no significant changes in the diastolic indices of the patients with PS, but later the abnormal indices became normal with an improvement in the RVW and IVS hypertrophy. These data indicate that the LV hypertrophy may be related to the small LV and the high EF in the AS group before BV. Also, the RVW hypertrophy, the IVS hypertrophy, and the RV high pressure load to the LV through the IVS may be related to the small LV, high EF, and abnormal two chamber inflow in the PS group before BV. This small LV could maintain the cardiac output by elevating EF.(ABSTRACT TRUNCATED AT 400 WORDS)