The characteristics and outcomes of patients undergoing percutaneous balloon pulmonary valvuloplasty in the paediatric population

Abstract

Background The immediate results along with short term and medium term results of percutaneous balloon pulmonary valvuloplasty (PBPV) for the treatment of pulmonary stenosis (PS) have been well documented in literature. On the other hand the results on long term follow up are few. The purpose of this study was to document the immediate, short and long term results of PBPV and, to analyse the characteristics and outcomes of patients who have undergone PBPV at Inkosi Albert Luthuli Central Hospital (IALCH) Department of Paediatric Cardiology in Durban South Africa. Methods The study comprised of 30 patients (20 females/67%, 10 males/33%) with isolated congenital pulmonary stenosis who underwent PBPV from June 2005 to June 2012. Their age ranged from 23 days to 11 years. Patients underwent clinical examination, angiography (Pre and post PBPV) and echocardiography on the day after the procedure, at 6 months and at one year. The difference in clinical examination and diagnostic findings were described over the above three time periods. Results The results were categorized as “excellent” when the Peak Transvalvular systolic gradient (PTSG) was reduced by more than 50mmHg after the procedure, “good” when the PTSG was reduced by 25-50mmHg and “poor” when the PTSG was less than 25mmHg. The mean pre PBPV pullback systolic pressure between the main Pulmonary Artery (MPA) to right ventricular outflow tract (RVOT) was 20.2±7.60 mmHg to 78.1±27.78 mmHg. The mean pre PBPV systolic pullback pressure gradient between the MPA to RVOT was 60.03±32.10. The mean post PBPV pullback systolic pressure between the MPA to RVOT was 20.13±8.22 mmHg to 48.13±24.47 mmHg. The mean post PBPV pullback systolic pressure gradient between the MPA to RVOT was 28.73±23.21 The mean±SD initial echocardiographic gradient was 110.1±35.58 mmHg. The mean±SD echocardiographic gradient the day after PBPV was 54.37±26.53 mmHg (excellent), the mean±SD echocardiographic gradient at the 6 months follow-up was 54.9±28.10 mmHg (excellent) and the mean±SD echocardiographic gradient at the one year follow-up was 53.2±32.27 mmHg (excellent). Patients with Mild Pulmonary stenosis 9/30(30%) showed mean±SD reduction in the gradient between pre-procedure echocardiographic findings and at one year follow-up by 41.30±20.10 mmHg (good). Patients with moderate pulmonary stenosis 9/30(30%) showed post PBPV with a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 70.92±24.90 mmHg (excellent). Patients who presented with severe pulmonary stenosis [12/30(40%)] showed a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 81.21±35.85 mmHg (excellent). Procedural complications included pulmonary regurgitation occurring in 16/30(53%) of patients and tear of a leaflet occurring in one patient 1/30(4%). The remaining 13/30(43 %) presented with no procedural complications. Conclusion In this study Percutaneous Balloon Pulmonary Valvuloplasty as a treatment option of pulmonary stenosis in children showed excellent immediate, short and long term results.