[Percutaneous balloon valvuloplasty for severe and critical pulmonary valve stenosis in infants under six months].
OBJECTIVE
To assess the effects and potential role of percutaneous balloon valvuloplasty as an alternative therapy of surgery in young infants with severe and critical pulmonary valve stenosis.


METHODS
Eighteen patients aged 8 days to 6 months with severe and critical pulmonary valve stenosis admitted to our hospital from June 2006 to August 2008 underwent balloon valvuloplasty. Among them, 11 infants including 2 neonates had critical pulmonary stenosis. Severe tricuspid regurgitation was seen in 5 and moderate in 3. Right ventricular systolic pressure in all patients was greater than systemic pressure with right-to-left or bi-directional shunt at atrial level. Dilatation was performed under general anesthesia with intubation in 12 patients and caudal block combined with sedation in 6 patients. Dilatation with 2 balloons sequentially in one procedure was performed in 6 patients and dilatation with 1 balloon in other 10 patients.


RESULTS
Of the 18 patients, there was failure to cross the pulmonary valve with balloon catheter in one and cardiac tamponade in one. The dilatation success rate was 88.9%. Immediately after dilatation, the systemic pressure gradient from right ventricle to pulmonary artery decreased from (87 +/- 24) mm Hg to (30 +/- 19) mm Hg (P < 0.01). No complication was found in all patients during or post dilation. During a follow-up of 6 to 32 months, pressure gradient crossing pulmonary valve measured by echocardiography further decreased or remained stable in 16 cases, except one neonate and one infant whose pressure gradient gradually increased and required a second dilatation. Re-dilatation rate was 12.5%. Tricuspid regurgitation was reduced in all patients. Mild pulmonary regurgitation was seen in most of patients post-dilatation, except moderate in one. All patients fared well and stayed asymptomatic.


CONCLUSIONS
Percutaneous balloon valvuloplasty for severe and critical pulmonary stenosis in infants is relatively safe and effective and should be considered a valid alternative to surgical operation. It should be the first choice for such patients based on its excellent outcome, less trauma and fewer complications.
Liu
Fang
F
Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China. liufanga@hotmail.com
Wu
Lin
L
Huang
Guo-ying
GY
Zhang
Li-feng
LF
Qi
Chun-hua
CH
Ma
Xiao-jing
XJ
Liang
Xue-cun
XC
D021721:Balloon Occlusion; D002404:Catheterization / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011664:Pulmonary Valve; D011666:Pulmonary Valve Stenosis / Q000628:therapy*; D016896:Treatment Outcome