BALLOON VALVULOPLASTY IN CONGENITAL PULMO NARY VALVE STENOSIS IN CHILDHOOD

Background: We report on our experiences with balloon valvuloplasty in pulmonary valve stenosis which was performed between 1986 and 1993 in 36 patients (average age 3.57 +/- 3.80 years, range 8 days to 12 year s). Method: The indication for balloon valvuloplasty were pulmonary va lve gradients above 60 mmHg. Before and after the balloon valvuloplast y the transvalvular gradient was determined by cardiac catheterization at follow-up by Doppler echocardiography. Results: The median reducti on of the pulmonary valve gradient was 69 +/- 19% from 80 +/- 22 mm Hg to 25 +/- 20 mm Hg (p < 0.001). Of the 36 patients 33 were followed u p in the first year after valvuloplasty, 19 in the second year and 11 in the third year. The transvalvular gradient of these patients was 25 +/- 11/21 +/- 9/22 +/- 13 mm (p < 0.001), respectively. Mild pulmonar y insufficiency was seen in 24 patients after the procedure and incomp lete right bundle branch block was observed in is patients. 2 severe c omplications were seen between 1986 and 1989, leading to death in one patient. In one patient we had an intimal tearing without consequences . After 1989 no severe complications were observed. Conclusion: The re sults of this procedure show a smaller mortality rate than following s urgical valvotomy. Thus, the balloon valvuloplasty of congenital pulmo nary valve stenosis is the method of first choice. However, balloon va lvuloplasty should not be used in patients with dysplastic valves.