Percutaneous balloon valvuloplasty for the treatment of pulmonary valve stenosis in children - a single centre experience.
BACKGROUND
Isolated pulmonary valve stenosis (PVS) is a common heart defect (6-9%); the preferred treatment is balloon pulmonary valvuloplasty (BPV).


OBJECTIVE
To assess BPV results in children with isolated PVS treated between 1988 and 2004, with a mean follow-up of 6.1 +/- 3.4 years.


METHODS
The studied group consisted of 137 children (76 males and 61 females), aged 5.4 +/- 4.8 years. The diagnosis was based on physical examination, ECG, chest radiograph, echo, haemodynamic and angiocardiographic studies. The patients were divided into three groups, depending on the ratio of right ventricular systolic (RVSP) to systemic pressure (SP): I (n = 58) - RVSP < or = 75% of SP, II (n = 41) - RVSP = 76-100% of SP, III (n = 38) - RVSP > 100% of SP. In 7.3% of patients, dysplastic pulmonary valve (DPV) was seen. The balloon diameter to pulmonary valve annulus ratio was 1.29 +/- 0.1, and 1.42 +/- 0.1 in DPV children.


RESULTS
Immediately post-BPV, the patients showed significantly (p < 0.001) decreased pressure gradient across PVS (I: 49.3 +/- 11.1 - 12.5 +/- 7.6, II: 75.6 +/- 12.3 - 17.0 +/- 13.0, III: 117.3 +/- 28 - 17.9 +/- 15.5 mmHg), decreased RVSP (I: 65.3 +/- 10.3 - 28.6 +/- 7.6, II: 91.7 +/- 11.6 - 35.0 +/- 14, III: 133.0 +/- 27.3 - 38.4 +/- 19.2 mmHg) and end-diastolic RV pressure (I: 6.2 +/- 3.0 - 5.6 +/- 7.6, II: 6.3 +/- 3.0 - 5.5 +/- 2.9, III: 8.5 +/- 3.0 - 7.2 +/- 2.3 mmHg), non-significant (p > 0.05) increase in pulmonary artery pressure in group I (15.8 +/- 1.1 - 16.8 +/- 0.9 mmHg) and II (15.8 +/- 1.2 - 17.8 +/- 1.3 mmHg) and a significant (p < 0.003) rise in group III (14.5 +/- 1.3 - 19.4 +/- 2.1 mmHg). The procedure was ineffective only in one (2.4%) child in group II, who required surgery. Complications were seen in five (3.6%) patients, including one case of a balloon being lodged in the iliac vein (surgical repair). Follow-up echo showed similar to immediate post BPV values of pressure gradients across PVS. Pre-BPV subpulmonary stenosis was seen in 5.1%, post-BPV - 15.3%, and end of follow-up - only 3.6% of children, mainly from group III. Pre-BPV tricuspid insufficiency > IIo was noted in 8.8%, significantly more frequently in group III; while in late follow-up, it was seen in 7.2%, e.g. twice as often in group III vs. groups I and II. Pulmonary regurgitation > IIo increased from 2.2% before BPV to 25.5%, i.e. 17.2%, 24.4% and 39.5%, respectively in groups I-III. Restenosis was observed in eight (5.8%) patients (group I - 1, III - 7), of whom five had re-BPV, two were operated on and one was disqualified due to insignificant restenosis.


CONCLUSIONS
These long-term follow-up data confirm efficacy and safety of BPV performed in children with isolated PVS.
Weryński
Piotr
P
Department of Pediatric Cardiology, Jagiellonian University Collegium Medicum, Krakow, Poland. werpiotr@interia.pl
Rudziński
Andrzej
A
Król-Jawień
Wanda
W
Kuźma
Jacek
J
D001794:Blood Pressure; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology; D011665:Pulmonary Valve Insufficiency / Q000209:etiology; D011666:Pulmonary Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence