title: Percutaneous balloon dilation of severe pulmonary valve stenosis in patients with cyanosis and congestive heart failure.
abstract: OBJECTIVE
  This article reports outcomes of percutaneous balloon dilation in patients with severe pulmonary valve stenosis, in particular in those treated late with cyanosis, congestive heart failure, and pericardial effusion.
  
  
  BACKGROUND
  Percutaneous balloon dilation is the treatment of choice for pulmonary valve stenosis. Although earlier intervention may produce better results, patients may present late with congestive heart failure and cyanosis.
  
  
  METHODS
  Fifty-five patients who underwent pulmonary valve balloon dilation, were grouped into two groups, based on the presence or absence of congestive right heart failure and/or central cyanosis. Group I included 33 patients with severe pulmonary valve stenosis, but without clinical evidence of congestive right heart failure in the form of liver enlargement, raised jugular venous pressure, and peripheral edema and/or central cyanosis and group II included 22 patients with severe pulmonary valve stenosis and congestive right heart failure and/or central cyanosis. Their outcomes were compared.
  
  
  RESULTS
  Doppler measured transvalvar pressure gradient decreased from 110.2 ± 34.0 mm Hg before to 52.5 ± 28.7 mm Hg in group I after dilation (P < 0.001), and from 138.4 ± 32.3 mm Hg to 53.9 ± 19.3 mm Hg in group II, (P < 0.001). Complications included ventricular tachycardia/fibrillation in three patients and severe bradycardia in one patient in group II. Twelve patients in group II developed clinical and radiologic evidence of reperfusion injury/pulmonary edema within the first 24 hr of intervention and needed ventilation for 2-9 days. Three of these patients died from intractable pulmonary edema. On follow up, clinical and echocardiographic improvement parameters were similar in the two groups.
  
  
  CONCLUSIONS
  Those patients with severe pulmonary valve stenosis with congestive right heart failure, especially those with pericardial effusion, ascites and cyanosis, represent an important technical and clinical challenge. They are a high-risk group with or without treatment. If they survive the procedure, they may still remain at a high risk in the first few days afterward. Maintaining their ventilator and inotropic support after balloon dilation may increase survival. However, excellent results can be obtained.
authors: Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University and Cardiac Center, Addis Ababa, Ethiopia.
authors: Endale
authors: E
authors: Tefera
authors: Shakeel A
authors: SA
authors: Qureshi
authors: Ramón
authors: R
authors: Bermudez-Cañete
authors: Lola
authors: L
authors: Rubio
mesh_terms: D000293:Adolescent; D000328:Adult; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology; D011654:Pulmonary Edema / Q000209:etiology; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: elective ventilation; end-stage right ventricular failure; graded balloon dilation; pulmonary edema; reperfusion injury