Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children.
BACKGROUND
We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for pulmonary valve stenosis in infants and children.


METHODS
Results after surgical pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 +/- 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 +/- 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, pulmonary valve insufficiency, and tricuspid valve insufficiency were considered.


RESULTS
Mean pressure gradient decreased significantly more in the surgical group (from 64.8 +/- 30.8 mm Hg to 12.8 +/- 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 +/- 21.4 mm Hg to 21.5 +/- 15.9 mm Hg after a mean of 5.4 years; p < 0.001). Moderate pulmonary valve insufficiency occurred in 44% after surgery, and in 11% after BV (p < 0.001). Tricuspid valve insufficiency occurred in 2% after surgery, and in 5% after BV. Restenosis occurred in 3 surgical patients (5.6%), 2 patients required reoperation, and 1 patient required a balloon valvotomy. Restenosis developed in 13 BV patients (14.1%): 6 patients were redilated and 7 patients required surgery. Surgical valvotomy led to significantly less reinterventions than balloon valvuloplasty (p < 0.04).


CONCLUSIONS
Surgical relief of pulmonary valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated pulmonary valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed.
Peterson
Claire
C
Division of Cardiology, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands.
Schilthuis
Johanneke J
JJ
Dodge-Khatami
Ali
A
Hitchcock
J Francois
JF
Meijboom
Erik J
EJ
Bennink
Ger B W E
GB
D002404:Catheterization; D002675:Child, Preschool; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006345:Heart Septal Defects, Ventricular / Q000150:complications; D006801:Humans; D007223:Infant; D011664:Pulmonary Valve / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies