open access

Vol 67, No 4 (2009)
Other
Published online: 2009-04-21
Submitted: 2012-12-28
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Original article
Percutaneous balloon valvuloplasty for the treatment of pulmonary valve stenosis in children – a single centre experience

Piotr Weryński, Andrzej Rudziński, Wanda Król-Jawień, Jacek Kuźma
Kardiol Pol 2009;67(4):369-375.

open access

Vol 67, No 4 (2009)
Other
Published online: 2009-04-21
Submitted: 2012-12-28

Abstract


Background: Isolated pulmonary valve stenosis (PVS) is a common heart defect (6-9%); the preferred treatment is balloon pulmonary valvuloplasty (BPV).
Aim: To assess BPV results in children with isolated PVS treated between 1988 and 2004, with a mean follow-up of 6.1 ± 3.4 years.
Methods: 100% of SP. In 7.3% of patients, dysplastic pulmonary valve (DPV) was seen. The balloon diameter to pulmonary valve annulus ratio was 1.29 &plusmn; 0.1, and 1.42 &plusmn; 0.1 in DPV children. Results: Immediately post-BPV, the patients showed significantly (p < 0.001) decreased pressure gradient across PVS (I: 49.3 &plusmn; 11.1 - 12.5 &plusmn; 7.6, II: 75.6 &plusmn; 12.3 - 17.0 &plusmn; 13.0, III: 117.3 &plusmn; 28 - 17.9 &plusmn; 15.5 mmHg), decreased RVSP (I: 65.3 &plusmn; 10.3 - 28.6 &plusmn; 7.6, II: 91.7 &plusmn; 11.6 - 35.0 &plusmn; 14, III: 133.0 &plusmn; 27.3 - 38.4 &plusmn; 19.2 mmHg) and end-diastolic RV pressure (I: 6.2 &plusmn; 3.0 - 5.6 &plusmn; 7.6, II: 6.3 &plusmn; 3.0 - 5.5 &plusmn; 2.9, III: 8.5 &plusmn; 3.0 - 7.2 &plusmn; 2.3 mmHg), non-significant (p > 0.05) increase in pulmonary artery pressure in group I (15.8 &plusmn; 1.1 - 16.8 &plusmn; 0.9 mmHg) and II (15.8 &plusmn; 1.2 - 17.8 &plusmn; 1.3 mmHg) and a significant (p < 0.003) rise in group III (14.5 &plusmn; 1.3 - 19.4 &plusmn; 2.1 mmHg). The procedure was ineffective only in one (2.4%) child in group II, who required surgery. Complications were seen in five (3.6%) patients, including one case of a balloon being lodged in the iliac vein (surgical repair). Follow-up echo showed similar to immediate post BPV values of pressure gradients across PVS. Pre-BPV subpulmonary stenosis was seen in 5.1%, post-BPV &#8211; 15.3%, and end of follow-up &#8211; only 3.6% of children, mainly from group III. Pre-BPV tricuspid insufficiency > IIo was noted in 8.8%, significantly more frequently in group III; while in late follow-up, it was seen in 7.2%, e.g. twice as often in group III vs. groups I and II. Pulmonary regurgitation > IIo increased from 2.2% before BPV to 25.5%, i.e. 17.2%, 24.4% and 39.5%, respectively in groups I-III. Restenosis was observed in eight (5.8%) patients (group I &#8211; 1, III &#8211; 7), of whom five had re-BPV, two were operated on and one was disqualified due to insignificant restenosis.
Conclusions: These long-term follow-up data confirm efficacy and safety of BPV performed in children with isolated PVS.

Abstract


Background: Isolated pulmonary valve stenosis (PVS) is a common heart defect (6-9%); the preferred treatment is balloon pulmonary valvuloplasty (BPV).
Aim: To assess BPV results in children with isolated PVS treated between 1988 and 2004, with a mean follow-up of 6.1 &plusmn; 3.4 years.
Methods: 100% of SP. In 7.3% of patients, dysplastic pulmonary valve (DPV) was seen. The balloon diameter to pulmonary valve annulus ratio was 1.29 &plusmn; 0.1, and 1.42 &plusmn; 0.1 in DPV children. Results: Immediately post-BPV, the patients showed significantly (p < 0.001) decreased pressure gradient across PVS (I: 49.3 &plusmn; 11.1 - 12.5 &plusmn; 7.6, II: 75.6 &plusmn; 12.3 - 17.0 &plusmn; 13.0, III: 117.3 &plusmn; 28 - 17.9 &plusmn; 15.5 mmHg), decreased RVSP (I: 65.3 &plusmn; 10.3 - 28.6 &plusmn; 7.6, II: 91.7 &plusmn; 11.6 - 35.0 &plusmn; 14, III: 133.0 &plusmn; 27.3 - 38.4 &plusmn; 19.2 mmHg) and end-diastolic RV pressure (I: 6.2 &plusmn; 3.0 - 5.6 &plusmn; 7.6, II: 6.3 &plusmn; 3.0 - 5.5 &plusmn; 2.9, III: 8.5 &plusmn; 3.0 - 7.2 &plusmn; 2.3 mmHg), non-significant (p > 0.05) increase in pulmonary artery pressure in group I (15.8 &plusmn; 1.1 - 16.8 &plusmn; 0.9 mmHg) and II (15.8 &plusmn; 1.2 - 17.8 &plusmn; 1.3 mmHg) and a significant (p < 0.003) rise in group III (14.5 &plusmn; 1.3 - 19.4 &plusmn; 2.1 mmHg). The procedure was ineffective only in one (2.4%) child in group II, who required surgery. Complications were seen in five (3.6%) patients, including one case of a balloon being lodged in the iliac vein (surgical repair). Follow-up echo showed similar to immediate post BPV values of pressure gradients across PVS. Pre-BPV subpulmonary stenosis was seen in 5.1%, post-BPV &#8211; 15.3%, and end of follow-up &#8211; only 3.6% of children, mainly from group III. Pre-BPV tricuspid insufficiency > IIo was noted in 8.8%, significantly more frequently in group III; while in late follow-up, it was seen in 7.2%, e.g. twice as often in group III vs. groups I and II. Pulmonary regurgitation > IIo increased from 2.2% before BPV to 25.5%, i.e. 17.2%, 24.4% and 39.5%, respectively in groups I-III. Restenosis was observed in eight (5.8%) patients (group I &#8211; 1, III &#8211; 7), of whom five had re-BPV, two were operated on and one was disqualified due to insignificant restenosis.
Conclusions: These long-term follow-up data confirm efficacy and safety of BPV performed in children with isolated PVS.
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Keywords

pulmonary valve stenosis; balloon pulmonary valvuloplasty; pulmonary insufficiency

About this article
Title

Original article
Percutaneous balloon valvuloplasty for the treatment of pulmonary valve stenosis in children – a single centre experience

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 67, No 4 (2009)

Pages

369-375

Published online

2009-04-21

Bibliographic record

Kardiol Pol 2009;67(4):369-375.

Keywords

pulmonary valve stenosis
balloon pulmonary valvuloplasty
pulmonary insufficiency

Authors

Piotr Weryński
Andrzej Rudziński
Wanda Król-Jawień
Jacek Kuźma

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