Major Determinants and Long-Term Outcomes of Successful Balloon Dilatation for the Pediatric Patients with Isolated Native Valvular Pulmonary Stenosis: A 10-Year Institutional Experience

Abstract

PurposeWe report herein major determinants and long-term outcomes of balloon dilatation (BD) for 27 pediatric patients with isolated native valvular pulmonary stenosis (VPS).Materials and MethodsFrom May 1997 to May 2003, 27 pediatric patients with VPS (pressure gradients ≧ 40 mmHg) were enrolled in this retrospective study. Single-balloon maneuver was applied in 26 patients, and double-balloon maneuver in 1. After BD, the pressure gradients were documented simultaneously by pullback maneuver by cardiac catheterization and echocardiography within 24 hours, at 1-month, 3-month, 1-year, and 4-to-10-year follow-ups.ResultsBefore BD, the echocardiographic gradients ranged from 40 to 101 mmHg (61 ± 19, 55), and from 40 to 144 mmHg (69 ± 32, 60) by pressure recordings. After BD, the gradients ranged from 12 to 70mmHg (29 ± 13, 27) by pressure recording (p < 0.001), and from 11 to 64 mmHg (27 ± 12, 26) by echocardiography within 24 hrs (p < 0.001). The ratios of the systolic pressure of the right ventricle to those of the left ventricle were 55 to 157% (89 ± 28, 79%) before BD, and 30 to 79% (47 ± 13, 42%) after BD (p < 0.001). Follow-up (7.7 ± 5.7, 4.5 years) echocardiographic gradients ranged from 11 to 61 mmHg (25 ± 11, 24). Two patients did not have immediate success owing to infundibular spasm. Improved right ventricular compliance could be accounted for the ultimate success in these 2 patients. The ultimate successful rate was 100%.ConclusionBD can achieve excellent long-term outcomes in the pediatric patients with isolated native VPS.