Long-term invasive and noninvasive results of percutaneous balloon pulmonary valvuloplasty in children, adolescents, and adults

Abstract

Background: Short-term and mid-term results of percutaneous balloon pulmonary valvuloplasty (BPV) are well known. However, data documenting long-term effectiveness of BPV are scarce. Methods and Results: The long-term results of 62 patients were assessed by catheterization and Doppler echocardiography 1 to 10 years (mean 6.4 ± 3.4) after BPV. Mean age of the patients was 13.5 ± 10.5 years (range 9 months to 44 years). Twenty patients were 16 years of age or older. Right ventricular peak systolic pressure was systemic or suprasystemic in 72% of patients. A double-balloon technique was used in 29 patients. The balloon–to–pulmonary valve diameter ratio was 1.4 ± 0.38 (range 1 to 1.8). Total systolic transpulmonary pressure gradient in excess of 50 mm Hg in all patients before BPV decreased from 98 ± 40 to 32 ± 23 immediately after BPV and to 19 ± 9 mm Hg at follow-up (P < .001). Infundibular gradient increased from 8 ± 10 to 14 ± 24 mm Hg after BPV and fell to 1 ± 4 mm Hg at follow-up (P < .01). In 16 patients it was ≥20 mm Hg and virtually disappeared spontaneously in all at follow-up. The valvar gradient fell from 93 ± 39 to 19 ± 11 (P < .001) and was 18 ± 9 mm Hg at follow-up. It remained unchanged in 3 patients (range 36 to 45 mm Hg). In 3 (4.8%) other patients, a new gradient >35 mm Hg developed that was ≥50 mm Hg in all 3. Among 5 patients having dysplastic valves, 3 had a gradient >35 mm Hg. There were no predictors of a gradient >35 mm Hg at long-term follow-up by univariate or multivariate Cox proportional hazards analysis. Mild to moderate pulmonary regurgitation was present in 39% of patients. On electrocardiography, right ventricular hypertrophy decreased significantly in 90% of patients. Conclusions: BPV as a treatment of typical pulmonic valve stenosis produces excellent long-term results. Restenosis is rare (4.8%) and occurs more frequently in patients with dysplastic valves. There is a constant spontaneous regression of associated infundibular obstruction. (Am Heart J 1999;138:950-4.)