title: Intervention in Patients with Critical Pulmonary Stenosis in the Ductal Stenting Era.
abstract: We aimed to assess early and midterm outcomes of balloon valvuloplasty (BVP) procedure in patients with critical pulmonary stenosis (CPS) and to describe the predictors of the need for additional pulmonary flow and reintervention in this subgroup of patients. From 2005 to 2014, 56 neonates were diagnosed with CPS and were included in this study. All echocardiographic, catheterization and angiographic data obtained prior to the initial BVP and at follow-up were reviewed. BVP was successful in 55 neonates (98 %). Twenty-one neonates needed pulmonary blood flow augmentation after BVP (38 %). Ductal stenting (DS) was performed in 20. The patients' mean tricuspid valve (TV) annulus diameter was 10.4 ± 2 mm, and the Z score was -1.29 ± 1 (-3.7 to 0.78). The mean pulmonary valve (PV) annulus diameter was 6 ± 0.9 mm, and the Z score was -1.74 ± 1 (-4.34 to 0.05). A transcatheter or surgical reintervention was performed in 11 patients. A TV Z score < -1.93 SD predicted the need for pulmonary blood flow augmentation after a successful BVP, with a sensitivity of 63.2% and a specificity of 84.4%. A PV Z score < -1.69 SD predicted the need for pulmonary flow augmentation, with a sensitivity of 74 %. The presence of bipartite RV was found to be a significant predictor of the need for reintervention (odds ratio 9.6). Our study showed the excellent immediate outcomes of BPV and DS in a pure cohort of patients with CPS. Prophylactic DS in selected cases seems reasonable and safe.
authors.affiliation: Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street Nr. 13, Üsküdar, Istanbul, Turkey.
authors.forename: Ilker Kemal
authors.initials: IK
authors.lastname: Yucel
authors.affiliation: Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street Nr. 13, Üsküdar, Istanbul, Turkey.
authors.forename: Mustafa Orhan
authors.initials: MO
authors.lastname: Bulut
authors.affiliation: Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street Nr. 13, Üsküdar, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kucuk
authors.affiliation: Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street Nr. 13, Üsküdar, Istanbul, Turkey. drsevketballi@hotmail.com.
authors.forename: Sevket
authors.initials: S
authors.lastname: Balli
authors.affiliation: Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street Nr. 13, Üsküdar, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Celebi
mesh_terms: D063126:Balloon Valvuloplasty; D002404:Catheterization; D004452:Echocardiography; D006801:Humans; D007231:Infant, Newborn; D011664:Pulmonary Valve; D011666:Pulmonary Valve Stenosis; D015607:Stents; D016896:Treatment Outcome
keywords: Critical pulmonary stenosis; Ductal stenting; Reintervention