title: Single-stage balloon valvuloplasty for critical pulmonary valve stenosis in the neonate.
abstract: Balloon valvuloplasty (BV) in neonates with critical pulmonary valve stenosis (CPVS) is limited by technical considerations, mainly the difficulty of traversing the stenotic valve. To simplify the procedure we used a 4F Cobra Type I catheter to cross the pulmonary valve (PV) without the aid of a guidewire, and performed single-stage BV, using low-profile balloons, in 12 neonates with CPVS. Procedure and total fluoroscopy times were 69 +/- 33 min (42-125 min) and 34 +/- 19 min (20-58 min), respectively. Following BV, right ventricular systolic pressure (RVSP) decreased from 102 +/- 17 mm Hg to 56 +/- 15 mm Hg (p < 0.001); and the ratio of RVSP to aortic systolic pressure decreased from 1.39 +/- 0.22 to 0.73 +/- 0.21 (p < 0.001). No significant complications were observed. BV failed in two patients, who subsequently had surgery. At follow-up (a mean of 19 months), Doppler gradient was 19 +/- 12 mm Hg (0.50 mm Hg). BV was repeated in one patient. We conclude that in neonates with CPVS, the use of the 4F Cobra type I catheter facilitates crossing of the PV and allows performance of BV in a single stage; this enhances safety and time-efficiency, and shortens exposure to radiation.
authors.affiliation: Department of Pediatric Cardiology, Aghia Sophia Athens Children's Hospital, Greece.
authors.forename: B
authors.initials: B
authors.lastname: Thanopoulos
authors.forename: F
authors.initials: F
authors.lastname: Triposkiadis
authors.forename: G S
authors.initials: GS
authors.lastname: Tsaousis
mesh_terms: D006328:Cardiac Catheterization; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010101:Oxygen Consumption; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D014654:Vascular Patency