[Percutaneous valvotomy in critical neonatal pulmonary stenosis. Results and mid-term follow up].
BACKGROUND
Catheter-balloon valvotomy has been proposed as an alternative to surgical valvotomy in the critical pulmonary stenosis in newborns.


OBJECTIVE
The present report describes the results, complications and follow-up of this technique at our center.


RESULTS
From May 1993 to June 1998, fourteen consecutive patients with critical pulmonary stenosis underwent balloon valvotomy. Their mean ages were 8.7 +/- 5.8 days. Each of them was cyanotic and ten of the fourteen were on prostaglandin E1 therapy and three of them required endotracheal intubation and ventilation. The diameters of balloons were 9.6 +/- 2.1 mm (range, 5 to 12 mm) and the balloon/annulus diameter ratio was 1.3 +/- 0.2 (range, 0.8 to 1.5). By means of this technique, right ventricle systolic pressure decreased from 95.2 +/- 22.4 mmHg to 51 +/- 23.2 mmHg (p < 0.001) and the right ventricle/aortic pressure ratio decreased from 1.5 +/- 0.4 to 0.8 +/- 0.3 (p < 0.001). Surgical valvotomy was performed in two patients (cases 1 and 8) at 5-months and 3 days, respectively, from the balloon valvotomy. One patient (case 4) required a blalock-taussig shunt. Complications included cardiac tamponade in one patient. One patient died seven days after successful valvotomy by extracardiac complications. All eleven patients are currently symptom free 26.6 +/- 17.1 months later (range, 5 to 56) and Doppler residual gradient ranges from 0 to 29 mmHg (11.1 +/- 10.4 mmHg).


CONCLUSIONS
Balloon pulmonary valvotomy is an effective and relatively safe technique for treatment of critical pulmonary stenosis in newborns with low index complication and mid-term relief of valvular obstruction.
Benito Bartolomé
F
F
Sección de Hemodinámica, Hospital Infantil La Paz, Madrid.
Sánchez Fernández-Bernal
C
C
Torres Feced
V
V
D000367:Age Factors; D000792:Angiography; D021721:Balloon Occlusion; D002404:Catheterization; D003627:Data Interpretation, Statistical; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors