Outcomes for balloon pulmonary valvuloplasty in adults: Comparison with a concurrent pediatric cohort

Abstract

To compare procedural outcomes of transcatheter balloon pulmonary valvuloplasty (BPV) in adults to a concurrent pediatric cohort and to identify whether BPV leads to improvement in symptoms among adults. BPV has long been utilized to relieve right ventricular outflow tract (RVOT) obstruction in neonates and young children. More recently, BPV has been performed in adults, but outcome data are limited in this population. We reviewed all cases of BPV performed at Mayo Clinic's Congenital Cardiac Cath Lab from December 1993 to July 2012. Patients were excluded if they had additional congenital heart defects, other than simple left-to-right shunt lesions. 89 children and 40 adults underwent 132 BPV procedures. Among the adults, 78% were symptomatic at the time of BPV. The most common symptoms were dyspnea and fatigue. RVOT systolic gradient was 42 ± 19 mmHg (children) and 54 ± 26 mmHg (adults) prior to BPV (P = 0.002). Adults experienced a greater reduction in gradient following BPV (32 ± 21 mmHg vs. 23 ± 19 mmHg; P = 0.007). No patients exhibited "suicide right ventricle" physiology after BPV. Among adults, mean follow-up was 1.9 years (30 days-11 years). Symptoms improved in 20 of the 24 previously symptomatic adults for whom follow-up data were available. Mean NYHA score improved from 2.2 to 1.4 following BPV. At last follow-up, 52% of adults were free of any symptoms, a significant improvement from pre-BPV (P = 0.0003). Only one patient described worsening of symptoms after BPV. BPV is an effective procedure for symptomatic adults with pulmonary valve stenosis. In addition to immediate relief of RVOT gradient, adult patients may experience symptomatic improvement following BPV.