title: Immediate- and medium-term effects of balloon pulmonary valvuloplasty in infants with critical pulmonary stenoses during the first year of life: A prospective single center study.
abstract: BACKGROUND
  Balloon pulmonary valvuloplasty (BPV) represents the standard of management for all patients with severe pulmonary stenosis (PS) irrespective of their age. Nevertheless neonates and infants with critical PS represent a high-risk group that needs to be studied.
  
  
  METHODS
  The study population included 72 infants with severe congenital valvular PS and four infants with imperforate pulmonary valve (PV) who were subjected to detailed history taking, full clinical examination, resting 12-lead ECG, Chest roentgenogram and transthoracic echocardiography. BPV was attempted in all infants with a peak-to-peak gradient across the PV of 50 mmHg or greater at catheterization-laboratory. Full echocardiographic evaluation was done 24 hours after the procedure as well as 3 and 6 months later.
  
  
  RESULTS
  Seventy-six infants with severe PS or imperforate PV with a mean age of 5.63 ± 2.99 months were subjected to BPV with or without wire perforation. Immediately after the procedure patients had a significant reduction of the right ventricular systolic pressure (RVSP) (104.69 ± 24.98 mm Hg Vs 43.6 ± 13 mm Hg, p < 0.001) and RV-PA systolic pressure gradient (PG) (82.5 ± 23.76 mm Hg Vs 17.35 ± 8.96 mm Hg, p < 0.001). The immediate success rate defined as the drop in the RVSP to less than or equal to 50% of the baseline measurement was achieved in 85% of the cases. There was a progressive drop in the PG across the PV by Doppler echocardiogram throughout a follow-up period of six months from a mean of 93.3 ± 28.2 mm Hg to a mean of 17.4 ± 10.42 mm Hg (p < 0.001). There was a significant increase of the mean PV annulus diameter after balloon dilatation (p < 0.001). There was also a highly significant inverse correlation between the growth of the pulmonary annulus and the annular size at the baseline before dilatation (r = -0.74, p value <0.001). The incidence of PR significantly increased immediately after BPV to 64% followed by a progressive decline over a 6 months period of follow-up to 20%. There was a significant decrease in the incidence of tricuspid regurgitation (TR) over the same period of follow-up (from 55.6% at baseline to less than 20% at follow-up).
  
  
  CONCLUSIONS
  BPV is safe and effective to relieve critical PS in infants during the first year of life. The balloon promotes advantageous changes in both, pulmonary annulus and PG across the RVOT. In addition, the Doppler gradient observations during the follow-up support the expectation that BPV is a "curative" therapy.
authors: Cardiology Department, Ain Shams University Hospital, Cairo, Egypt.
authors: Manal Hassan
authors: MH
authors: Saad
authors: Alaa Mahmoud
authors: AM
authors: Roushdy
authors: Maiy Hamdy
authors: MH
authors: Elsayed
keywords: ASD, atrial septal defect; BPV, balloon pulmonary valvuloplasty; BSA, body surface area; Balloon pulmonary valvuloplasty; Critical pulmonary stenosis; ECG, electrocardiogram; Infants; PADP, pulmonary artery diastolic pressure; PASP, pulmonary artery systolic pressure; PDA, patent ductus arteriosus; PFO, patent foramen ovale; PG, pressure gradient; PR, pulmonary regurgitation; PS, pulmonary stenosis; PV, pulmonary valve; RV, right ventricle; RVDP, right ventricular diastolic pressure; RVOT, right ventricular outflow tract; RVSP, right ventricular systolic pressure; TR, tricuspid regurgitation; TTE, transthoracic echocardiography; VSD, ventricualr septal defect
references: Kardiol Pol. 2009 Apr;67(4):369-75
references: 19492249
references: Am Heart J. 2007 Mar;153(3):433-8
references: 17307424
references: J Am Coll Cardiol. 1996 Feb;27(2):473-8
references: 8557923
references: Am Heart J. 1996 May;131(5):1007-11
references: 8615288
references: Pediatrics. 2001 Mar;107(3):E32
references: 11230613
references: J Am Coll Cardiol. 1988 Apr;11(4):821-4
references: 3351149
references: Clin Cardiol. 1993 Jun;16(6):497-502
references: 8358884
references: Rev Esp Cardiol. 2000 Mar;53(3):327-36
references: 10712965
references: Am Heart J. 1999 Nov;138(5 Pt 1):950-4
references: 10539828
references: Catheter Cardiovasc Interv. 2002 Jul;56(3):394-9
references: 12112896
references: Cardiol Young. 2003 Oct;13(5):444-50
references: 14694939
references: Int J Cardiol. 1993 Jun 15;40(1):17-25
references: 8349362
references: Tunis Med. 2000 Jan;78(1):30-6
references: 10894033
references: Catheter Cardiovasc Interv. 2009 Nov 1;74(5):753-61
references: 19496127
references: N Engl J Med. 1982 Aug 26;307(9):540-2
references: 7099226
references: Ann Thorac Surg. 1990 Feb;49(2):273-8
references: 2306149
references: Pediatr Clin North Am. 1999 Apr;46(2):427-39, xi
references: 10218084
references: J Am Coll Cardiol. 2002 Jun 19;39(12):1890-900
references: 12084585
references: Am J Cardiol. 1993 May 15;71(13):1246-8
references: 8480662
references: J Am Coll Cardiol. 1995 Dec;26(7):1725-31
references: 7594110
references: Br Heart J. 1976 May;38(5):472-82
references: 944584
references: Rev Port Cardiol. 2004 Jan;23(1):55-63
references: 15058147
references: J Invasive Cardiol. 2003 Sep;15(9):484-7
references: 12947206
references: Catheter Cardiovasc Interv. 2007 Apr 1;69(5):747-63
references: 17330270