Results of three to 10 year follow up of balloon dilatation of the pulmonary valve

Background-The results of immediate and short term follow up of balloon dil atation of the pulmonary valve have been well documented, but there is limi ted information on long term follow up. Objective-To evaluate the results of three to 10 year follow up of balloon dilatation of the pulmonary valve in children and adolescents. Setting-Tertiary care centre/university hospital. Design-Retrospective study. Methods and results-85 patients (aged between 1 day and 20 years, mean (SD) 7.0 (6.4) years) underwent balloon dilatation of the pulmonary valve durin g an 11 year period ending August 1994. There was a resultant reduction in the peak to peak gradient from 87 (38) to 26 (22) mm Hg. Immediate surgical intervention was not required. Residual gradients of 29 (17) mm Hg were me asured by catheterisation (n = 47) and echo Doppler (n = 82) at intermediat e term follow up (two years). When individual results were scrutinised, nin e of 82 patients had restenosis, defined as a peak gradient of 50 mm Hg or more. Seven of these patients underwent repeat balloon dilatation of the pu lmonary valve: peak gradients were reduced from 89 (40) to 38 (20) mm Hg. C linical evaluation and echo Doppler data of 80 patients showed that residua l peak instantaneous Doppler gradients were 17 (15) mm Hg at long term foll ow up (three to 10 years, median seven), with evidence for late restenosis in one patient (1.3%). Surgical intervention was necessary to relieve fixed infundibular stenosis in three patients and supravalvar pulmonary stenosis in one. Repeat balloon dilatation was performed to relieve restenosis in t wo patients. Actuarial reintervention free rates at one, two, five, and 10 years were 94%, 89%, 88%, and 84%, respectively. Pulmonary valve regurgitat ion was noted in 70 of 80 patients at late follow up, but neither right ven tricular dilatation nor paradoxical interventricular septal motion develope d. Conclusions-The results of late follow up of balloon dilatation of the pulm onary valve are excellent. Repeat balloon dilatation was performed in 11% o f patients and surgical intervention for subvalvlar or supravalvar stenosis in 5%. Most patients had mild residual pulmonary regurgitation but right v entricular volume overload did not develop and surgical intervention was no t required. Balloon dilatation is the treatment of choice in the management of moderate to severe stenosis of the pulmonary valve. Further follow up s tudies should be undertaken to evaluate the significance of residual pulmon ary regurgitation.