title: Balloon valvuloplasty in dysplastic pulmonary valve stenosis: immediate and intermediate outcomes.
abstract: OBJECTIVE
  To determine the immediate and intermediate outcome in dysplastic and doming pulmonary valve stenosis in children and to determine various factors associated with unsuccessful outcome.
  
  
  METHODS
  An interventional study.
  
  
  METHODS
  The Children's Hospital, Lahore, Pakistan, from June 2006 to December 2012.
  
  
  METHODS
  All patients presenting with severe pulmonary valve stenosis were enrolled in the study. Balloon valvuloplasty was performed on all patients. Successful outcome (residual gradient < 36 mmHg) was compared with matched doming pulmonary valve stenosis control group valvuloplasty. Difference in various quantitative variables was calculated using independent t-test and Mann Whitney U test. Categorical variables were compared using Chi square and Kruskal-Wallis test. Multivariate analysis was performed to determine various factors associated with outcome. Kaplan- Meier survival table was used to determine freedom from re-intervention proportions.
  
  
  RESULTS
  One hundred and fifty two patients (Dysplastic group A, n=73; Doming group B, n=79) with median age of 24 months (range 3 - 192 months) and M:F; 2:1 were included in the study. Mean gradient decreased from 96 ± 33 mmHg to 29 ± 20 mmHg. Group A had significantly higher number of patients with unsuccessful outcome (9.6%, p=0.02). Preprocedure gradient > 75 mmHg was the most significant factor associated with unsuccessful outcome (p < 0.001). Median follow-up duration was 3 years (range 1 - 6 years). Freedom from re-intervention proportion at 1, 3 and 6 years was 91.3%, 86.7% and 78.9% respectively in group A compared to 100%, 96.5% and 96.5% respectively in group B. Immediate postprocedure gradient > 60 mmHg was the only significant factor associated with re-intervention in group A (p=0.001).
  
  
  CONCLUSIONS
  The results from balloon valvuloplasty in dysplastic pulmonary valve were suboptimal when compared to doming valves. However, it provides a high freedom from re-intervention rate in intermediate follow-up. Intervention at moderate severity can result in better outcome.
authors.affiliation: Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore.
authors.forename: Tayyaba
authors.initials: T
authors.lastname: Sehar
authors.affiliation: Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore.
authors.forename: Ahmad Usaid
authors.initials: AU
authors.lastname: Qureshi
authors.affiliation: Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore.
authors.forename: Uzma
authors.initials: U
authors.lastname: Kazmi
authors.affiliation: Department of Paediatric Cardiology, Combined Military Hospital, Lahore.
authors.forename: Amjad
authors.initials: A
authors.lastname: Mehmood
authors.affiliation: Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore.
authors.forename: Syed Najam
authors.initials: SN
authors.lastname: Hyder
authors.affiliation: Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Lahore.
authors.forename: Masood
authors.initials: M
authors.lastname: Sadiq
mesh_terms: D000293:Adolescent; D063126:Balloon Valvuloplasty / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011664:Pulmonary Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011666:Pulmonary Valve Stenosis / Q000151:congenital / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography