Intermediate-term outcome after pulmonary balloon valvuloplasty: Comparison with a matched surgical control group

Abstract

To assess late (4 to 5 years) gradient reduction after pulmonary balloon valvuloplasty in childhood, and to compare the effectiveness of valvuloplasty with that of surgical valvotomy, 20 valvuloplasty-treated children and their age- and gradientmatched surgical control patients underwent prospective, noninvasive evaluation. The average age at intervention was 4.3 ± 1 years for the valvuloplasty group versus 4.7 ± 0.8 years for the surgical control group (p = NS). Before intervention the peak systolic pulmonary stenosis gradient was 76 ± 5 and 74 ± 4.4 nun Hg for the valvuloplasty and surgery groups, respectively (p = NS).Late evaluation consisted of clinical examination, two-dimensional echocardiogram and Doppler study, 24-hour Holter monitoring, 12-lead electrocardiogram, exercise treadmill study and chest radiograph performed an average of 5.3 ± 0.3 years after valvuloplasty and 11.7 ± 0.5 years after surgery (p < 0.01). The patients treated with balloon valvuloplasty had no evidence of restenosis; the residual pulmonary stenosis gradient at follow-up was 24 ± 2.7 mm Hg (range 8 to 48) versus 35 ± 3.6 mm Hg (range 19 to 70) immediately after valvuloplasty (p = NS).Comparison of the late residual gradients between treatment groups showed no hemodynamicallysignificant difference (24 ± 2.7 versus 16 ± 1.5 mm Hg, balloon versus surgery; p < 0.01). However, there was, a significant difference in the degree and severity of pulmonary valve insufficiency and ventricular ectopic activity between groups. In the balloon valvoplasty group 11 patients had no pulmonary insufficiency, and the remaining 9 had mild insufficiency. In the surgery group 9 had mild and 9 had moderate valve insufficiency (p < 0.01). Ventricular ectopic activity was absent in 19 w the balloon valvuloplasty group, and the remaining patient had Lown grade 1 ventricular ectopic activity. In contrast, 6 children in the surger group had complex ventricular arrhythmia (p < 0.01).In summary, compared with surgical valvotomy, balloon, valvuloplasty for isolated valvular pulmonary stenoss provides nearly equivalent long-term gradient relief with less valvular insufficiency and less late ventricular ectopic activity.