Abstract
Objectives: Factors influencing results of balloon valvuloplasty (BVP) of pulmonary valve stenosis (PS) in children are investigated. Background: BVP has become the standard of care for PS, medium-term results are not uniform and depend on various preconditions. Methods: We analysed the medium-term results of BVP of PS in children in an observational, single centre study. Need for additional procedure was defined as outcome after initial BVP. Results: We included 143 children (83 female) at a median (IQR) age of 2.6 (0.26–9.24) months and body weight of 5 (3.4–8) kg at BVP with a follow–up of 5.04 (1.6–10.2) years. We used balloon size of 10 (9–14) mm and maximal balloon pressure of 4 (3.5–10) atm, resulting in balloon–to–pulmonary annulus ratio of 1.28 (1.2–1.4). Systolic pressure gradient of PS was reduced with BVP (43.5 mmHg vs. 14.0 mmHg, p < 0.001) and confirmed by echocardiography (68.0 mmHg vs. 25.0 mmHg, p < 0.001) day 1 post procedure. Pulmonary BVP with associated supravalvular PS resulted in a relevant reduction of systolic pressure gradient in 23 of 31 patients (74.2%). Early additional procedure was necessary in 14 patients (9.8%) after 0.2 (0.1–0.7) years due to residual PS (n = 13) and infective endocarditis (n = 1). Factors for additional procedures were associated supravalvular PS with a higher residual pressure gradient, but not genetic syndrome. During further follow–up of 5.04 (1.6–10.2) years no further additional procedures were needed. Conclusions: Pulmonary BVP of native pulmonary valve stenosis leads to excellent medium-term results, even in 3 of 4 infants with associated supravalvular obstruction sufficient pressure relief can be obtained.
Highlights
Pulmonary valve stenosis (PS) is a congenital heart defect (CHD) causing an obstruction of the right ventricular outflow tract at the valvular level
3.1 Patients Pulmonary balloon valvuloplasty was performed in 218 patients between February 2002 and March
We report on 143 patients fulfilling the inclusion criteria with native PS treated with balloon valvuloplasty (BVP). 112 patients had an isolated valvular PS without additional supravavlular obstruction, 31 (21.7%) patients had a combined valvular and supravalvular PS
Summary
Pulmonary valve stenosis (PS) is a congenital heart defect (CHD) causing an obstruction of the right ventricular outflow tract at the valvular level. PS is common with an incidence of 0.7 per 1000 live births [1]. It may occur isolated or in combination with other types of CHD such as Tetralogy of Fallot with subvalvular or supravalvular pulmonary stenosis [2]. In newborns with critical PS with duct dependent pulmonary blood flow central cyanosis may be the leading symptom due to interatrial right-left-shunt [4]. Beside these clinical findings, the diagnosis of PS is made by transthoracic echocardiography and interventional and surgical treatment options are available for PS [3]. BVP of PS is the standard treatment for native PS in children [6–8] with acceptable results [9,10]
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