IMMEDIATE RESULTS OF PERCUTANEOUS PULMONA RY VALVULOPLASTY IN CHILDREN AND ADULTS

Between April 1987 and December 1993, 60 consecutive patients with val vular pulmonary stenosis underwent percutaneous balloon valvuloplasty in the cardiology department of Monastir. The average age was 13.9 +/- 10.9 years (3 days-44 years). Fifteen patients were over 17 years of age and 4 were less than one year old. The right ventricular systolic pressure fell from 116.5 +/- 39.5 mmHg to 55 +/- 19.7 mmHg (p < 0.0001 ) immediately after the procedure. The peak-to-peak systolic gradient between the right ventricle and pulmonary artery fell from 95.4 +/- 40 .2 mmHg to 30.4 +/- 19.0 mmHg (p < 0.00001), the valvular-gradient fel l from 87.5 +/- 39.6 mmHg to 14.7 +/- 11.1 mmHg (p < 0.00001) and the infundibular pressure gradient increased slightly from 8.0 +/- 14.0 mm Hg to 15.6 +/- 18.6 mmHg (p = 0.06). The systolic pulmonary artery pre ssure increased from 21.6 +/- 6.0 mmHg to 25.2 +/- 6.3 mmHg (p = 0.001 5). The mean pulmonary artery pressure from 15.6 +/- 4.8 mmHg to 17.3 +/- 4.9 mmHg (p = 0.028). There were no changes in pulmonary diastolic pressures (10.6 +/- 3.7 mmHg vs 9.2 +/- 3.5 mmHg, p = 0.6). There wer e 4 primary failures (6.4 %) with residual valvular gradients greater than or equal to 30 mmHg, including one due to valvular dysplasia. No predictive factors of primary failure could be identified. An infundib ular gradient greater than or equal to 20 mmHg was observed in 11 pati ents, 4 of whom had gradients greater than or equal to 50 mmHg (6.6 %) ; two gradients were residual and 2 were created by pulmonary valvulop lasty. The total gradient and infundibular gradient before dilatation were predictive of an infundibular gradient greater than or equal to 2 0 mmHg immediately after valvuloplasty (p = 0.04). Percutaneous pulmon ary valvuloplasty was fatal in one 3 days old neonate due to necrosing enterocolitis. Percutaneous pulmonary valvuloplasty is the treatment of choice of valvular pulmonary stenosis in children and adults. It is usually an easy and low risk procedure except in neonates. The immedi ate results are good in most cases. A residual gradient is common usua lly due; to an infundibular reaction or, more rarely, to valvular sten osis.