PERCUTANEOUS BALLOON VALVULOPLASTY FOR PULMONIC STENOSIS IN ADOLESCENTS AND ADULTS

Background Percutaneous balloon valvuloplasty has been the accepted fi rst-line treatment for congenital pulmonic stenosis in children. Its e fficacy in adolescents and adults is less well defined. Methods Betwee n December 1985 and July 1995 we performed percutaneous pulmonic valvu loplasty with a single Inoue balloon catheter in 53 adolescent or adul t patients 13 to 55 years of age (mean [+/-SD], 26+/-11). Follow-up st udies were performed 0.2 to 9.8 years after the procedure (mean, 6.9+/ -3.1) by Doppler echocardiography (in all the patients) and by cardiac catheterization and angiography (in nine patients). Results After bal loon valvuloplasty, the systolic pressure gradient across the pulmonic valve decreased from 91+/-46 mm Hg to 38+/-32 mm Hg (P<0.001), and th e diameter of the pulmonic-valve orifice increased from 8.9+/-3.6 mm t o 17.4+/-4.6 mm (P<0.001). In the nine patients catheterized at follow up, the systolic gradient decreased from 107+/-48 mm Hg before valvulo plasty to 50+/-29 mm Hg after valvuloplasty and to 30+/-16 mm Hg at fo llow-up (P<0.001 for the comparison of the gradient before and after v alvuloplasty; P<0.001 for the comparison before valvuloplasty and at f ollow-up; and P<0.05 for the comparison after valvuloplasty and at fol lowup). In the same nine patients, the diameter of the pulmonic valve, as measured by right ventricular angiography, increased from 8.3+/-1. 4 mm before valvuloplasty to 17.2+/-2.0 mm after valvuloplasty (P<0.00 1) and to 18.4+/-1.4 mm at follow-up (P=0.08). Incompetence of the pul monic valve was noted in 7 of the 53 patients (13 percent) after ballo on valvuloplasty, but it had disappeared at followup in all of them. C onclusions Patients with congenital pulmonic stenosis who present in l ate adolescence or adult life can be treated with percutaneous balloon valvuloplasty with excellent short-term and long-term results that ar e similar to those in young children. (C)1996, Massachusetts Medical S ociety.