Balloon Pulmonary Valvuloplasty Research Articles

Safety and efficacy of balloon pulmonary valvuloplasty

Balloon pulmonary valvuloplasty (BPV) is the treatment of choice for patients with pulmonary valve stenosis (PS); however, safety and efficacy outcomes are lacking in the current era. Demographic, procedural, and adverse event (AE) data were prospectively collected using a multicenter registry (C3PO) and cases performed between 02/07 and 06/10 at eight institutions. The registry was queried for cases of isolated BPV. Multivariable models were built to determine risk factors for procedure failure and adverse outcomes. 211 cases were included (45%, <1 month). Procedural success was achieved in 91% procedures, being defined as one or more of the following: post-BPV peak systolic valvar gradient to < 25 mm Hg (88%), decrease in gradient by 50% (79%), or reduction of RV/systemic pressure ratio by 50% (45%). Procedural success was more common in neonates, when compared to older patients (96% vs. 87%, P = 0.03). Risk factors for procedural failure included moderate or severe pulmonary valve thickening (OR 2.9, CI 1-8.3), and presence of supravalve PS (OR 9.6, CI 2.7-33.8). Low severity AEs (levels 1-2) occurred in 9% of patients and higher severity AEs (levels 3-5) occurred in 3% of patient; there were no deaths. Risk factors for any AE (levels 1-5) were age below 1 month (OR 3.5, CI 1.3-8.9), as well as operator experience of less than 10 years (OR 3.8, CI 1.5-9.9). Procedural success is common and AEs, especially higher severity AEs, are rare for BPV in patients with isolated PS. Results have improved considerably when compared to historical data.

OUTCOMES OF PULMONARY BALLOON VALVULOPLASTY FOR ISOLATED PULMONARY VALVE STENOSIS IN CHILDREN

Pulmonary balloon valvuloplasty (PBV) is considered a safe and effective treatment for children with pulmonary valve (PV) stenosis. Few studies evaluate the long term outcomes, particularly the incidence of pulmonary regurgitation (PR). We evaluated the outcomes of children > 1 year following PBV.

Fetal Ebstein's anomaly: early and late appearance

To present sonographic findings in early and late appearance of fetal Ebstein's anomaly. Fetal sonography was performed in 53,447 consecutive pregnant women at 14 to 16 weeks' gestation. Ebstein's anomaly was detected in eight fetuses, in four of them additional anomalies were observed. All eight pregnancies were terminated. In an additional fetus, a normal four-chamber view without valvular regurgitation was visualized at 15 weeks' gestation. At 24 weeks, a normal four-chamber view was depicted. No Doppler examination was performed at that time. The newborn was found to have Ebstein's anomaly with pulmonary stenosis. A balloon pulmonary valvuloplasty was performed with a good outcome at three months of age. Fetal Ebstein's anomaly may be detected in early pregnancy. The incidence is higher than what is reported in newborns. Depiction of a normal fetal heart in early and midpregnancy does not exclude the possibility of subsequent development of Ebstein's anomaly.

Diagnosis and treatment of children with pulmonary stenosis

Pulmonary valve stenosis is a common congenital heart disease,and its early diagnosis and treatment can improve growth and prognosis in children with pulmonary valve stenosis.With the development of the diagnostics and treatment,percutaneous balloon pulmonary valvuloplasty has replaced surgery as the first choice for isolated pulmonary valve stenosis.This paper reviews the recent progress in diagnosis and treatment of pulmonary valve stenosis. Key words: Percutaneous balloon pulmonary valvuloplasty; Pulmonary valve stenosis; Surgery; Children

Application research of transvalvular pressure gradient by real-time color Doppler echocardiography in percutaneous balloon pulmonary valvuloplasty

Objective To assess the value of transvalvular pressure gradient (TPG) by use of realtime color Doppler echocardiography in percutaneous balloon pulmonary valvuloplasty (PBPV).Methods Patients with pulmonic stenosis (80 cases) were performed by PBPV,in which the pilmonic annular diameter and TPG were measured by using of 2-D and color Doppler echocardiography in the different periods of this operation.Results The pilmonic annular diameter was not significantly difference by intraoperative echocardiography and radiography measurement (t =2.013,P ＞ 0.05).And pressure measurement by catheterization pre- and post-dilatation was not markedly significant ( t =1.258,P ＞0.05).However,TPG in patients with the different degree of pulmonic stenosis were decreased significantly ( P ＜0.01).PBPV treatments in the mild pulmonic stenosis for twice got an excellent effect according to operation criteria,but PBPV treatment in patients with the moderate and severe pulmonic stenosis need to be done for three times.Conclusions Real-time color Doppler echocardiography is an effective way and plays a guiding role in PBPV. Key words: Echocardiography; Pulmonary valve stenosis; Balloon dilatation; Transvalvular pressure

Pulmonary Balloon Valvuloplasty during Pregnancy.

Women with valvular heart disease have an increased risk of adverse outcomes in pregnancy; however, with appropriate evaluation and treatment, most women can successfully bear healthy children. During pregnancy, pulmonary stenosis is generally well tolerated in the absence of other haemodynamically significant lesions. We present a case of a multiparous woman,who is pregnant with her sixth child, with a severe pulmonary stenosis. She presented with exertional chest pain and dyspnea. She was managed successfully with balloon valvuloplasty.

The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot

The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot

Percutaneous Balloon Pulmonary Valvuloplasty

Congenital pulmonary valve stenosis is a common congenital heart disease. Isolated pulmonary valve stenosis comprises 8-10% of all congenital heart disease. While surgical pulmonary valvotomy has been available as a treatment since 1956, it requires a median sternotomy, use of cardiopulmonary bypass, and post-surgical ICU admission with multi-day hospitalization. Recognizing the potential advantages of a less invasive approach, the first attempts at percutaneous catheter-based dilation of stenotic pulmonary valves were performed in the 1950s. As the technique was refined and catheter and balloon technology have advanced, the results of balloon pulmonary valvuloplasty have improved and the approach has become the standard of care for treating pulmonary valve stenosis. The purpose of this article is to discuss the anatomy and physiology of pulmonary valve stenosis, describe the techniques and current technology, and review the outcomes of balloon pulmonary valvuloplasty.

Profile of Patients with Congenital Heart Disease Submitted to Percutaneous Procedures at a Tertiary Centre: Analysis of 1,002 Cases

ABSTRACT Background Early diagnosis and treatment of congenital heart defects have a well-known impact on patient´s quality of life. This study aimed to describe the population of patients with congenital heart disease submitted to percutaneous diagnostic or therapeutic procedures at a tertiary referral center. Methods Retrospective analysis of 1,002 patients submitted to cardiac catheterization between 2003 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Clinical, demographic and procedure variables were obtained from an institutional database and patient charts. Results Median age was 33 (0-73) years and median weight was 23 (9.6-52.6) kg. Patients were predominantly females (52%), with acyanotic heart disease (63.2%) and postnatal diagnosis (94.8%). Pulmonary stenosis (22.9%), atrial septal defect (22.5%) and patent ductus ateriosus (21.6%) were the most common acyanotic heart defects, whereas tetralogy of Fallot was the most frequent cyanotic heart disease (15,2%). Most of the procedures (58,6%) were therapeutic, including pulmonary balloon valvuloplasty (32.9%), atrial septal defect closure (20.9%) and ductus arteriosus closure (15%). Complications were observed in 19.2% of patients, and inguinal hematomas (7.8%) and fever (7.6%) were the most frequent findings. There were 3 procedure-related deaths (0.3%). Conclusions The study results demonstrated the prevalence of therapeutic procedures in patients with acyanotic heart disease, performed with a low complication rate at a tertiary referral center.

Mid-Term Results of Balloon Pulmonary Valvuloplasty in Children at Queen Alia Heart Institute

Objective: To evaluate the mid-term results of balloon pulmonary valvuloplasty (BPV) in children. Design: Prospective study. Settings: Pediatric Cardiology Department of Queen Alia Heart (QAHI), Jordan. Methods: One hundred and thirty-two patients with a median age of 3 years (range 1 day to 16 years), underwent (BPV) between January 1999 and January 2006. We evaluated our patients with regard to peak pressure gradient across the right ventricular outflow tract before and after BPV. Thereafter we followed them at the Outpatient Clinic regarding the peak instantaneous gradient pressure, the pulmonary valve incompetence, right ventricular function based on echocardiographic findings, and the need for repeat BPV. Results: There was significant reduction in the peak to peak gradient from 93.5 ± 32.3 mmHg to 26.1 ± 9.6 mmHg (p &lt; 0.001). Echo-Doppler data showed that residual peak instantaneous gradient dropped from 26.1 ± 9. 6 to 19 ± 6 mmHg; (p &lt; 0.001) on follow-up for 6 years. Mild to moderarte pulmonary valve regurgitation was noticed in 34 patients (27.8%) at one year and in 43 patients (38%) at mid term follow-up, but non had right ventricular dilatation or paradoxical interventricular septal motion. Conclusions: The results of mid-term follow up after balloon dilatation of the pulmonary valve are encouraging. The degree of pulmonary regurgitation is increasing with time. Longer term follow-up studies should be undertaken to evaluate the significance of residual pulmonary regurgitation.

The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot

The late morbidity of pulmonary regurgitation has intensified the interest in valve-sparing repair of tetralogy of Fallot. This study reviewed a single institution's experience with valve-sparing repair and investigated the role of intraoperative balloon valvuloplasty. A retrospective chart review identified 238 patients who underwent complete primary repair of tetralogy of Fallot at less than 180 days of age. Patients were divided into 4 groups on the basis of the type of right ventricular outflow tract repair: transannular patch (n=111), commissurotomy or standard rigid dilation (n=71), intraoperative balloon pulmonary valvuloplasty (n=32), or no valvar intervention (n=24). Baseline demographic and anatomic factors differed among the 4 procedural groups with substantial overlap. Among 142 patients with pulmonary valve hypoplasia (z score, -2 to -4), 37% had valve-sparing repair. These patients had significant annular growth over time: z score increased 0.67 and 1.00 per year in the intraoperative balloon valvuloplasty (P<.001) and traditional valve-sparing (P<.001) groups, respectively. Rates of valve growth did not differ across groups, but z scores were 0.58 lower for the balloon valvuloplasty group across all time points (P=.001). Freedom from reintervention and surgery was shorter for the balloon valvuloplasty group than for the other groups (P<.001). Patients with tetralogy of Fallot and pulmonary valve hypoplasia who undergo valve-sparing repair with intraoperative balloon valvuloplasty have significant longitudinal annular growth, with normalization of annular size over time. Despite application in patients with more hypoplastic valves, balloon valvuloplasty resulted in similar valve growth and pulmonary regurgitation as traditional methods, but higher rates of reintervention. Although the precise role of this technique needs further refinement, it is likely to be most useful in patients with moderate pulmonary stenosis and moderate pulmonary valve dysplasia.

Hybrid Therapy for Pulmonary Atresia With Intact Ventricular Septum

In patients with pulmonary atresia with intact ventricular septum without right ventricular-dependent coronary circulation, catheter techniques, including the use of a stiff wire, lasers, and radiofrequency, have been most widely used for initial therapy; however, percutaneous perforation and balloon valvuloplasty have been associated with higher rates of procedural failure and serious complications. We report our experience with a hybrid approach involving the combination of surgery and interventional catheterization techniques for right ventricular decompression. Between March 2005 and April 2010, we performed a hybrid procedure in 30 newborns and infants (age, 1 day to 2 years; median age, 3 months) with favorable anatomy. The heart was exposed by performing midline sternotomy. A purse-string suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk. Then, a 16-gauge intravenous catheter was placed periventricular with the guidance of echocardiography to perforate the atretic pulmonary ventricle. Subsequently, a guide wire was inserted into the sheath and used to guide a balloon across the pulmonary ventricle. Sequential dilations were performed under the guidance of epicardial echocardiography until full opening of the pulmonary ventricle was obtained. In newborns, ductal ligation was performed, followed by modified Blalock-Taussig (mBT) shunt placement. Patients aged greater than 1 month were treated mostly with ductal ligation, and an mBT shunt was inserted if severe systemic oxygen desaturation occurred after ductal ligation; bidirectional Glenn shunt placement was performed if a patient showed severe hypoplasia. The hybrid procedure was successfully performed in all patients. Patent ductus arteriosus ligation was simultaneously performed in 27 cases. Six newborns were treated with mBT shunt placement after pulmonary valvuloplasty and patent ductus arteriosus ligation, and 2 patients aged greater than 1 month were treated with mBT shunt placement alone. Another 2 patients were selected for univentricular palliation with bidirectional Glenn procedure because of a diminutive monopartite right ventricle. No pericardial effusion or cardiac tamponade was observed. One patient in whom ductal ligation could not be performed was treated with mBT shunt placement because of hypoxemia 3 days after the hybrid procedure; the other patients were discharged without any further surgical intervention. During the follow-up period of 1.5 months to 5 years, 5 patients died; 25 (83.3%) survived and all were in New York Heart Association functional class 1. Saturation of peripheral oxygen in the survivors increased from 73.1±8.5% to 94±3.5% (p<001). Two-ventricle circulation was achieved in 24 patients, whereas 1 patient had a single-ventricle pathway. In conclusion, periventricular balloon pulmonary valvuloplasty using a hybrid approach was safe and feasible for patients with pulmonary atresia with intact ventricular septum.

Short term results of balloon pulmonary valvuloplasty in children: a single centre study over a period of 42 months

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Exercise capacity and ventricular function in patients treated for isolated pulmonary valve stenosis or tetralogy of Fallot

BackgroundWe hypothesized 1) that long-term ventricular outcome and exercise capacity would be better in patients with isolated pulmonary valve stenosis (PS) treated with balloon pulmonary valvuloplasty (BPV) than in patients operated for tetralogy of Fallot (TOF), and 2) that ventricular outcome and exercise capacity would not be different in PS patients and healthy controls. MethodsWe included 21 PS patients after BPV (16.2±5.2years) and 21 patients operated for TOF (16.6±5.6years), matching them for gender, age at treatment, and age at study. Patients underwent cardiovascular magnetic resonance (CMR) imaging, exercise testing, 12-lead ECG and 24-hour Holter monitoring for assessment of right ventricular (RV) size and function, pulmonary regurgitation (PR), exercise capacity and electrocardiographic status. Healthy controls for CMR imaging and exercise testing were matched for gender and age at study. ResultsRV volumes and PR percentage were significantly larger in TOF patients than in PS patients; biventricular ejection fraction (EF) was not different. PR was mild in most PS patients. RV end-systolic volume was significantly larger in PS patients than in healthy controls; RVEF was significantly lower. Both patient groups had similar exercise test results. Peak workload and VO2 max. were significantly lower in PS patients than in healthy controls. ConclusionsLongstanding mild PR in PS patients can lead to an enlarged RV, reduced RV function and reduced exercise capacity. Despite more PR and larger RV volumes in TOF patients, exercise capacity and biventricular function are similar in both patient groups.

Independent predictors of immediate and long-term results after pulmonary balloon valvuloplasty in dogs

Objectives Determine whether valve morphology, pulmonary annulus diameter, aortic/pulmonic annulus ratio, balloon-to-annulus ratio (BAR), pre-pulmonary balloon valvuloplasty (PBV), Doppler gradient, and residual Doppler gradient are independent predictors of immediate and long-term results after PBV in dogs as in humans. Animals, materials and methods Retrospective study. Medical records of dogs that underwent PBV, from January 1999 to December 2008 were reviewed. All dogs with pre- and immediate (24 h) post-PBV echocardiographic examination were included. 126 dogs were selected. Immediate outcome was optimal when the dog survived the PBV and Doppler gradient was ≤50 mmHg. Long-term outcome (1 year) was optimal when the dog survived at least 1-year follow-up without symptoms and Doppler gradient was ≤50 mmHg. Results Only pre-PBV Doppler gradient was identified as a significant independent predictor of immediate results ( P < 0.001; OR 0.97, CI 0.96–0.98). Pre-PBV Doppler gradient and residual Doppler gradient were the only independent predictors of long-term results ( P = 0.036; OR 0.98, CI 0.96–0.99 and P = 0.005; OR 0.95, CI 0.92–0.98, respectively). Conclusion In dogs as in humans higher pre-PBV Doppler gradient is one of the most important independent predictor of suboptimal immediate and long-term results after PBV and must be considered before scheduling this procedure. Moreover higher valvar residual Doppler gradient is an important independent predictors of suboptimal long-term results.

327: Prenatal tricuspid valve size as a predictor of postnatal outcome in patients with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum

Severe pulmonary stenosis and atresia (PS, PAIVS) are cardiac anomalies in which right ventricular (RV) outflow is obstructed. Depending on in utero RV growth in the face of this obstruction, severe PS and PA/IVS may exhibit a spectrum of severity, requiring postnatal interventions including balloon pulmonary valvuloplasty alone, surgical biventricular repair, or staged single-ventricle palliation. Tricuspid valve (TV) size at birth has been shown to predict outcome with a TV Z-score <-3 associated with single-ventricle outcome, but prenatal echocardiographic features that might predict postnatal TV size (and outcome) have not been as well studied.Our objective was to determine whether prenatal TV size or other echo-derived cardiac variables can predict favorable postnatal TV diameter in fetuses with PS and PA/IVS.

The diagnostic and interventional procedures performed in Angiography Laboratory of Pediatric Cardiology Section

Our aim was to compare the diagnostic and interventional procedures performed in our clinic and evaluate the increase in number and diversity of interventional procedures. Between July 2003 and May 2011 medical records of 1989 patients on whom diagnostic and interventional procedures had been performed was examined. 1036 of the patients (52%) were female and 953 of the patients (48%) were male. Diagnostic procedures were performed in 998 (50.2%) patients, while interventional procedures were performed in 991 (49.8%) patients. The interventional procedures are coil occlusion for patent ductus arteriosus, trans-catheter closure of atrial septal defect, pulmonary balloon valvuloplasty for pulmonary stenosis, aortic coarctation angioplasty, pericardiocentesis for pericardial effusion, aort balloon valvuloplasty for valvular aortic stenosis, permanent and temporary pacemaker insertion for acquired or congenital third degree atrioventricular block and /or sinus node disfunction in 321 (16.1%), 210 (10.6%), 146 (7.3%), 50 (2.5%), 45 (2.3%), 42 (2.1%), 40 (2%) and 33 (1.6%) patients; retrospectively. Interventional procedures were performed in 2,4 and 35 patients in 2003, 2004, and 2005; respectively. Following Angiography Laboratory of Pediatric Cardiology Section set up, interventional procedures were performed in 234 and 439 patients in 2009 and 2010; respectively. Number and variety of interventional procedures have been increased over the years after increased experience of Angiography Laboratory of Pediatric Cardiology Section. Diagnostic angiography procedures have been decreasing over the years by increase in development of new devices and progress of use of interventional treatment techniques. Therefore, interventional procedures have been replaced by diagnostic procedures.

Multiple transcatheter interventions in the same session in congenital cardiopathies

Background:To investigate the methods of percutaneous transcatheter interventions for combined congenital heart disease and to evaluate its efficacy in children.Materials and Methods:Thirty cases (ages 3 days-13.5 years, body weight 3-35 kg) that underwent two multiple transcatheter interventions for combined or solitary congenital heart disease were retrospectively analyzed and presented.Results:A total of 61 transcatheter interventions were performed in 30 patients as combined procedures. In 29 patients, two different procedures were combined in the same session, in remaining one patient, combination of three interventions were performed in the same catheter session. Interventions performed in combined procedures were as follows: Coarctation balloon angioplasty in 12 cases, pulmonary balloon valvuloplasty in 10, PDA coil embolization in 10, aortic balloon valvuloplasty in 8, VSD closure in 5, ASD closure in 4, ductal stent implantation in 4, palliative pulmonary balloon valvuloplasty in 3, recanalization and angioplasty of the systemic-pulmonary shunt in 2, balloon atrial septostomy in one, aortic coarctation stent implantation in one, coil embolization of a pulmonary lobar sequestration in one and pulmonary valve perforation plus pulmonary balloon valvuloplasty in one were performed as first or second procedure. There was no mortality or major morbidity in relation to combined procedures.Conclusion:Multiple transcatheter interventions in the same session are feasible, safe and effective with satisfactory good results. Second intervention may be performed as complementary procedure or independently to the first intervention.

E0538 Thanscatheter therapy of giant ventricular septal defect accompanied with critical pulmonary valve stenosis and high degree A-V block: a case report with 4 year follow-up

Transcatheter closure of ventricular septal defects, which has been used extensively in recent years, has become a treatment of choice in selected patients. However, there is relatively limited experience with...

Immediate- and medium-term effects of balloon pulmonary valvuloplasty in infants with critical pulmonary stenoses during the first year of life: A prospective single center study

Background Balloon pulmonary valvuloplasty (BPV) represents the standard of management for all patients with severe pulmonary stenosis (PS) irrespective of their age. Nevertheless neonates and infants with critical PS represent a high-risk group that needs to be studied. Methods The study population included 72 infants with severe congenital valvular PS and four infants with imperforate pulmonary valve (PV) who were subjected to detailed history taking, full clinical examination, resting 12-lead ECG, Chest roentgenogram and transthoracic echocardiography. BPV was attempted in all infants with a peak-to-peak gradient across the PV of 50 mmHg or greater at catheterization-laboratory. Full echocardiographic evaluation was done 24 hours after the procedure as well as 3 and 6 months later. Results Seventy-six infants with severe PS or imperforate PV with a mean age of 5.63 ± 2.99 months were subjected to BPV with or without wire perforation. Immediately after the procedure patients had a significant reduction of the right ventricular systolic pressure (RVSP) (104.69 ± 24.98 mm Hg Vs 43.6 ± 13 mm Hg, p < 0.001) and RV-PA systolic pressure gradient (PG) (82.5 ± 23.76 mm Hg Vs 17.35 ± 8.96 mm Hg, p < 0.001). The immediate success rate defined as the drop in the RVSP to less than or equal to 50% of the baseline measurement was achieved in 85% of the cases. There was a progressive drop in the PG across the PV by Doppler echocardiogram throughout a follow-up period of six months from a mean of 93.3 ± 28.2 mm Hg to a mean of 17.4 ± 10.42 mm Hg ( p < 0.001). There was a significant increase of the mean PV annulus diameter after balloon dilatation ( p < 0.001). There was also a highly significant inverse correlation between the growth of the pulmonary annulus and the annular size at the baseline before dilatation ( r = −0.74, p value <0.001). The incidence of PR significantly increased immediately after BPV to 64% followed by a progressive decline over a 6 months period of follow-up to 20%. There was a significant decrease in the incidence of tricuspid regurgitation (TR) over the same period of follow-up (from 55.6% at baseline to less than 20% at follow-up). Conclusion BPV is safe and effective to relieve critical PS in infants during the first year of life. The balloon promotes advantageous changes in both, pulmonary annulus and PG across the RVOT. In addition, the Doppler gradient observations during the follow-up support the expectation that BPV is a “curative” therapy.