Long-Term Outcomes of Balloon Valvuloplasty for Isolated Pulmonary Valve Stenosis.
To evaluate the long-term cumulative incidence of ≥ moderate pulmonary regurgitation (PR) and re-intervention following balloon pulmonary valvuloplasty (BPV). While BPV for pulmonary valve stenosis (PS) relieves obstruction acutely, long-term outcomes are not well documented. Between 1982 and 2002, 211 patients had BPV for isolated PS. Follow-up data were available for 103 patients. Cumulative incidence of ≥ moderate PR and re-intervention was evaluated and risk factors for ≥ moderate PR assessed in univariate and multivariable analyses. Median age at BPV was 0.7 years (range 1 day-42.2 years); peak catheter gradient was 65 mmHg (range 31-169 mmHg); 23% had critical PS. Sixty-two patients had a recent echocardiogram with median follow-up 15.1 years (range 10.1-26.3 years); 60% had ≥ moderate PR. Three patients had pulmonary valve replacement following BPV due to symptomatic severe PR. In univariate analysis, critical PS, younger age, smaller BSA, and smaller pulmonary annulus at the time of BPV, as well as greater baseline PS gradient by catheterization, were associated with ≥ moderate PR (all p < 0.05). In multivariable analysis, only BSA < 0.3 m2was independently associated with ≥ moderate PR (adjusted odds ratio 6.4, 95% confidence interval 1.2-33.6). In the largest study to date of > 10-year outcomes following BPV, 60% of patients with available follow-up data developed ≥ moderate PR. Few patients had pulmonary valve replacement. Patients with lower BSA at the time of BPV were more likely to have greater PR at late follow-up.
Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 631, Rochester, NY, 14642, USA. Rajiv_Devanagondi@urmc.rochester.edu.
Rajiv
http://orcid.org/0000-0003-1715-552X
R
Devanagondi
Department of Pediatrics, Mattell Children's Hospital, UCLA, Los Angeles, CA, USA.
Dan
D
Peck
Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Janaki
J
Sagi
Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Janet
J
Donohue
Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Sunkyung
S
Yu
Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Sara K
SK
Pasquali
Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
Aimee K
AK
Armstrong
D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008824:Michigan; D015999:Multivariate Analysis; D011664:Pulmonary Valve / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology*; D011666:Pulmonary Valve Stenosis / Q000150:complications* / Q000601:surgery*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
Balloon pulmonary valvuloplasty; Percutaneous intervention; Pulmonary valve disease