Long-term results of balloon pulmonary valvuloplasty of valvar pulmonic stenosis

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The purpose of this paper is to document long-term results of percutaneous balloon pulmonary valvuloplasty. Forty-one patients, aged 7 days to 20 years, underwent pulmonary valvuloplasty over a 3 1 2 -year period ending in April, 1987. Balloon valvuloplasty resulted in immediate reduction in the pulmonary valvar pressure gradient from 92 ± 45 to 30 ± 22 mm Hg ( p < 0.001). Follow-up (3 to 34 months) clinical, ECG, and echo Doppler data were available in 35 patients. Follow-up (6 to 34 months) cardiac catheterization data were available in 29 of the 35 patients. Short ejection systolic murmurs were heard in all 35, but an early diastolic decrescendo murmur was heard in only 12 patients. Based on the catheterization and Doppler data, the patients were divided into two groups: group I (30 patients) with excellent results and group II (five patients) with poor results (gradients > 50 mm Hg). In group I ECG right ventricular hypertrophy regressed. The echocardiographic right ventricular end-diastolic dimension (21 ± 6 vs 15.9 ± 4.6 mm) decreased ( p < 0.001) while the left ventricular dimension increased ( p < 0.02). Peak Doppler flow velocity in the main pulmonary artery fell from 4.0 ± 0.8 m/sec to 2.3 ± 0.5 m/sec ( p < 0.001). Doppler evidence for pulmonary insufficiency was present in 21 patients. Catheterization-determined pulmonary valvar gradients (24 patients) also fell from 95.6 ± 50.3 mm Hg to 18.3 ± 12.5 mm Hg ( p < 0.001). By contrast, in group II ECG, echocardiographic, and Doppler data and pulmonary valvar gradient at catheterization did not change significantly ( p > 0.1) but improved ( p < 0.01) following repeat balloon valvuloplasty. When the effects of balloon size on the results of valvuloplasty were scrutinized, balloons 1.2 to 1.4 times the size of the pulmonary valve anulus appear to produce sustained relief of pulmonary valve stenosis. These long-term results lead us to recommend balloon pulmonary valvuloplasty as a therapeutic procedure of choice for management of moderate to severe pulmonary valve stenosis.