Management of typical and dysplastic pulmonic stenosis, uncomplicated or associated with complex intracardiac defects, in juveniles and adults: use of percutaneous balloon pulmonary valvuloplasty with eight-month hemodynamic follow-up.
To alleviate large fixed right ventricular (RV) outflow gradients, percutaneous balloon dilatation of pulmonic stenosis (PS) was performed in 38 patients with mean age of 14 +/- 14 years (median: 9 years, age range: 9 months to 63 years). There were 21 males and 17 females. Thirty-four patients had typical PS (5 of them also having other complex congenital cardiac anomalies, while 13 additional patients had a patent foramen ovale); 2 further subjects had subpulmonic, and 2 dysplastic pulmonary valvular obstructions. Sixteen patients were in the New York Heart Association (NYHA) Class I, 15 in Class II, 6 in Class III, and 1 in Class IV. Electrocardiographic (ECG) evidence of right ventricular hypertrophy (RVH) was present in 29 patients (76%); 3 patients had right bundle branch block (RBBB). For the entire group, there was a marked decrease in the mean systolic transpulmonic gradient in the immediate post-valvuloplasty period (from 97 +/- 43 to 26 +/- 17 mmHg; P < 0.0001). One patient expired 8 hours post-valvuloplasty (he was in the NYHA Class IV, and had severe RV failure). No other cardiovascular complications were encountered; the median hospital stay was 3 days (range: 1-10 days). At an 8-month follow-up, 12 patients who were reevaluated invasively had a median transpulmonic gradient of 27 mmHg (range: 5-92 mmHg) as compared to their pre-valvuloplasty values of 84 mmHg (range: 49-142 mmHg; P < 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)
David
S W
SW
Department of Internal Medicine, Providence Hospital, Southfield, Michigan.
Goussous
Y M
YM
Harbi
N
N
Doghmi
F
F
Hiari
A
A
Krayyem
M
M
Ferlinz
J
J
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000002:abnormalities / Q000503:physiopathology; D011666:Pulmonary Valve Stenosis / Q000151:congenital / Q000503:physiopathology / Q000628:therapy*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D013599:Systole / Q000502:physiology