MANAGEMENT OF TYPICAL AND DYSPLASTIC PULMONIC STENOSIS, UNCOMPLICATEDOR ASSOCIATED WITH COMPLEX INTRACARDIAC DEFECTS, IN JUVENILES AND ADULTS - USE OF PERCUTANEOUS BALLOON PULMONARY VALVULOPLASTY WITH 8-MONTHHEMODYNAMIC FOLLOW-UP

To alleviate large fixed right ventricular (RV) outflow gradients, per cutaneous balloon dilatation of pulmonic stenosis (PS) was performed i n 38 patients with mean age of 14 +/-14 years (median: 9 years, age ra nge: 9 months to 63 years). There were 21 males and 17 females. Thirty -four patients had typical PS (5 of them also having other complex con genital cardiac anomalies, while 13 additional patients had a patent f oramen ovale); 2 further subjects had subpulmonic, and 2 dysplastic pu lmonary valvular obstructions. Sixteen patients were in the New York H eart Association (NYHA) Class I, 15 In Class II, 6 in Class III, and I in Class IV. Electrocardiographic (ECG) evidence of right ventricular hypertrophy (RVH) was present in 29 patients (76%); 3 patients had ri ght bundle branch block (RBBB). For the entire group, there was a mark ed decrease in the mean systolic transpulmonic gradient in the immedia te post-valvuloplasty period (from 97 +/- 43 to 26 +/-17 mmHg; P < 0.0 001). One patient expired 8 hours post-valvuloplasty (he was in the NY HA Class IV, and had severe RV failure). No other cardiovascular compl ications were encountered; the median hospital stay was 3 days (range: 1-10 days). At an 8-month follow-up, 12 patients who were reevaluated invasively had a median transpulmonic gradient of 27 mmHg (range: 5-9 2 mmHg) as compared to their pre-valvuloplasty values of 84 mmHg (rang e: 49-142 mmHg; P <0.004). Two patients restenosed; 1 required open-he art surgical valvulotomy with simple shaving, and 1 had successful red ilatation with balloon valvuloplasty. Our results indicate that balloo n pulmonary valvuloplasty (BPV) is a safe and effective procedure in m ost patients with PS. Percutaneous BPV should therefore be currently c onsidered to be an excellent alternative form of treatment for most, i f not all, subjects with a significant pulmonic valvular obstruction w ho might otherwise likely become the prime candidates for a severely c ompromised hemodynamic status if these defects were not expeditiously corrected.