Pulmonary Stenosis In Infants Research Articles

Right Ventricular Growth and Function After Balloon Valvuloplasty for Critical Pulmonary Valve Stenosis in Infants and Neonates.

Little data are published about right ventricular (RV) growth and function in infants and neonates after balloon pulmonary valvuloplasty (BPV) for critical valvular pulmonary stenosis (PS). We aimed to assess the RV growth and function during 1year after BPV for critical valvular PS in neonates and infants. A total of 41 infants and neonates with isolatedcriticalvalvular PSwho underwent BPV from August 2016 to Sep 2018 were enrolled in the study. Complete Echocardiographic examination was performed to all infants before, 1week, 1month, 3months, 6months, and 1year after BPV. The RV systolic pressure and transvalvular pulmonary pressure gradient significantly decreased 1week after BPV and continue to decrease more slowly during the period of follow-up. During follow-up, RV end-diastolic dimension increased significantly, whereas RV anterior wall thickness significantly decreased. The mean diameters of pulmonary valve annulus and tricuspid valve annulus significantly increased after BPV over the period of follow-up. RV systolic and diastolic dysfunction improved significantly as reported by reduced RV Tei index and tricuspid annular systolic velocity and increased RV E/A ratio. RV growth and function were significantly improved after BPV for critical PS in infants and neonates and catch-up growth of right ventricular structures occurred after 6months of BPV.

Catheterization‐based intervention in low birth weight infants less than 2.5 kg with acute and long‐term outcome

The number of low birth weight infants with congenital heart disease is increasing and catheterizations may have an increased risk for mortality and morbidity. We investigate the outcome and complications of cardiac catheterizations in infants weighing < 2.5 kg. Retrospective review of catheterization records from 1995 to 2010 in infants weighing < 2.5 kg. The demographics, procedure, outcome, and follow-up data were collected. Of 101 catheterizations performed in 88 patients, 45 (45%) catheterizations were interventional. Balloon atrial septostomy (n = 23), pulmonary valvuloplasty (14), aortic valvuloplasty (4), stent placement (3), balloon angioplasty (2), and temporary pacemaker insertion (1) were successfully performed. Balloon atrial septostomy was performed with pulmonary or aortic valvuloplasty in two catheterizations. Infants < 2.5 kg had higher significant adverse event rate that those 2.5-3.5 kg (13% versus 6.6%, P < 0.05). No procedural death was noted. Significant adverse events (n = 13) included cardiopulmonary resuscitation three, vascular six, arrhythmia three, and apnea requiring intubation one. On median follow-up of 3 years (0.03 to 14), n = 69, mortality rate was 36%. In six patients with valvar pulmonary stenosis with median follow-up of 6 years (0.75-13), four (67%) did not require re-intervention. Of two patients with aortic stenosis, one did not require repeat intervention for 6 years (last follow-up). Interventional catheterization is feasible with low procedural morbidity and mortality in high risk infants < 2.5 kg. Catheterization primarily serves as a palliative procedure to stabilize infants for definitive treatment. Balloon valvuloplasty may be effective for isolated valvar pulmonary stenosis in infants < 2.5 kg.

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.

Critical Pulmonary Stenosis in Infants and Neonates in the Era of Interventional Cardiology

Between September 1992 and February 1998, 22 consecutive patients aged 4 to 90 days with critical valvular pulmonary stenosis underwent percutaneous transluminal balloon valvuloplasty. Sixteen were cyanosed and 7 required prostaglandin infusion. The pulmonary valve was successfully crossed in all patients. Progressive dilatation was used to attain a final balloon to valve ratio between 1.2 and 1.4. Mean right ventricular systolic pressure dropped from 109 ± 26 to 34 ± 1 mm Hg. Oxygen saturation increased from 84% ± 8% to 98% ± 2%. There were 5 complications including 1 death due to valvular damage, 1 hemopericardium requiring drainage and transfusion, significant blood loss during cannulation in 2 cases, and a fractured guidewire that was retrieved in another. Repeat valvuloplasty was performed in 2 patients. Two patients required surgery; one had a dysplastic pulmonary valve with persistent pulmonary stenosis and the other had a hypoplastic right ventricle. Of the 20 patients who had valvuloplasty alone, 17 (85%) remained well with a mean peak systolic Doppler gradient of 30 ± 26 mm Hg and no pulmonary regurgitation. We concluded that valvuloplasty is likely to be the only procedure necessary for the majority of infants and neonates with critical pulmonary stenosis. However, surgery is required in cases of dysplastic pulmonary valve or hypoplastic right ventricle.

Balloon pulmonary valvuloplasty in infants and children: technique and immediate result.

Between 1986 and Feb. 1993, 20 patients with moderately severe isolated pulmonary stenosis underwent cardiac catheterization and balloon pulmonary valvuloplasty (BPV). Their ages ranged from 7 months to 11 years old (mean 6.2 years), their weights ranged from 8 to 45 kg (mean 14.5 kg). Immediately after BPV, the right ventricular pressure decreased from 89 +/- 21 to 46 +/- 16 mmHg (p < 0.005). The pressure gradient across the pulmonary valve reduced by 68%, from 68 +/- 23 to 24 +/- 16 mmHg (p < 0.005). There was no significant changes in both pulmonary artery pressure (19 +/- 4 versus 21 +/- 3 mmHg), and aortic pressure (102 +/- 11 versus 104 +/- 11 mmHg). Successful BPV (pulmonic pressure gradient < 36 mmHg) was achieved in 15 cases (75%). Among the 5 unsuccessful cases, 2 patients underwent redilatation which had excellent results. Another 2 patients received operations, one was a dysplastic pulmonary valve, the other was due to a gradient across the pulmonary valve > 120 mmHg before BPV. The remaining one had only 40 mmHg gradient after BPV, and he was doing well on follow-up. There were no significant complications in these series. BPV is an effective and safe procedure. It should be the treatment of choice for significant pulmonary stenosis in infants and children.

Pulmonary Stenosis in Infants and Young Children

Twenty-four patients less than 3 years old underwent operation for pulmonary stenosis. Pulmonary dysplasia was diagnosed preoperatively in only 4 patients; in 20 patients the lesion was categorized simply as pulmonary stenosis. At operation, more severe valve deformities were often present in patients less than 2 years of age. Preoperative evaluation did not reveal the extent of the deformity in 7 additional patients. The deformities included not only valvular dysplasia (thickened redundant valve cusps) but also supravalvular and annular abnormalities. Relief of obstruction was obtained only when all components of the obstructive abnormality were relieved. Patch angioplasty of the right ventricular outflow tract was necessary in 13 patients with complex morphology. Valvotomy was effective only for pulmonary stenosis due to pure commissural fusion. A spectrum of the morphology of pulmonary stenosis is recognized, with more complex lesions than simple commissural fusion identified in younger children. The more complex lesions may require more extensive operations (outflow tract patch) to completely relieve the obstructive pathological condition in the outflow tract.

Critical pulmonary stenosis in infants: A surgical emergency: S. B. Litwin, W. H. Williams, M. D. Freed, and W. F. Bernhard. Surgery 74: 880–886 (December), 1973

Critical pulmonary stenosis in infants: A surgical emergency: S. B. Litwin, W. H. Williams, M. D. Freed, and W. F. Bernhard. Surgery 74: 880–886 (December), 1973

Critical pulmonary stenosis in infants: a surgical emergency.

Critical pulmonary stenosis in infants: a surgical emergency.