Results of balloon valvuloplasty in typical and dysplastic pulmonary valve stenosis: Doppler echocardiographic follow-up

Abstract

To assess the usefulness of balloon valvuloplasty in patients with a dysplastic pulmonary valve, the files of 36 patients (aged 1 day to 18.5 years) who had two-dimensional echo-cardiography before and continuous wave Doppler echocartography late after balloon valvuloplasty (balloon diameter ≥20% anulus diameter) were reviewed. Results of relief of pulmonary stenosis were graded by catheter gradient in the catheterization laboratory and compared with Doppler echocardiographic findings at follow-up.There were 32 patients with typical pulmonary stenosis and 4 with a dysplastic valve. In the 32 patients with typical pulmonary stenosis, transvalvular gradient changed from a mean of 67 ± 32 to 20 ± 20 mm Hg (p < 0.0001, mean reduction 72.6%). The gradients at follow-up by Doppler echocardiography averaged 20 mm Hg including 15 that increased, 3 that were unchanged and 14 that decreased. Only 3 (9%) of 32 patients had a gradient >25 mm Hg at follow-up and only one gradient was >35 mm Hg. All four patients with a dysplastic valve had a gradient that decreased with valvuloplasty from a mean of 85 ± 33 to 33 ± 20 mm Hg (p < 0.05); gradient reduction in this group ranged from 40 to 85% (mean 57.5%). The gradient at follow-up increased in three of these four patients and decreased in one (the only late gradient <25 mm Hg). Late gradient was <35 mm Hg in two of the four patients and was reduced by 43 and 57%, respectively, in the other two.Pulmonary valvuloplasty with large balloons gives good results in nearly all cases of typical pulmonary stenosis and in some cases of dysplastic valve. Because valvuloplasty for a dysplastic pulmonary valve results in significant palliation or relief of gradient, patients with this condition should not be excluded from an attempt at valvuloplasty.