Late outcomes after pulmonary valve balloon dilatation in neonates, infants and children.
OBJECTIVE
This review was designed to document late outcomes after percutaneous balloon dilation (PBD) of the pulmonary valve (PV) on infants and children.


BACKGROUND
PBD is the treatment of choice for PV stenosis. While short and intermediate term results are excellent, late outcomes, with respect to growth of the right heart are poorly defined.


METHODS
Clinical data and serial echocardiograms were reviewed for children who had PBD between 1984 and 1992.


RESULTS
One-hundred and fifty children were identified. PV gradients decreased from 62+/-29 to 23+/-20 mmHg (p<0.0001) and remained low during a mean follow-up of 11.9+/-3.1 (range 3.7 to 19.3 years). Freedom from re-intervention at 1, 10 and 15 years were: 90%, 83%, and 77%. Pulmonary regurgitation (PR) increased during follow-up such that 57% of children had moderate or severe PR at last follow-up. These children tended to have a smaller body surface area (0.52 vs. 0.82 m2, p=0.04), were younger (3.1 vs. 5.9 years, p=0.004), and less likely to be syndromic (p=0.04). Only children with severe PR demonstrated a significant increase in right ventricular (RV) size. Tricuspid and pulmonary annuli grew with the child's growth, the PV demonstrating catch-up growth (PV z-score: negative 1.3 vs. negative 0.7 at last follow-up, p=0.04).


CONCLUSIONS
Following PBD in childhood, gradient reduction persists and RV structures grow appropriately in the majority of children. Although late PR occurs commonly, it is well tolerated. While life-long follow-up is essential, excellent outcome can be anticipated.
Cardiac Catheterization Laboratories, Department of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Yael
Y
Garty
Gruschen
G
Veldtman
Kyong
K
Lee
Lee
L
Benson
D000293:Adolescent; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011666:Pulmonary Valve Stenosis / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome