Sustained high pressure double balloon angioplasty of calcified conduits

Objective-To assess the efficacy of prolonged high pressure angioplasty for dilatation of calcified and stenotic cardiac conduits in children. Design-A prospective study of consecutive patients presenting with calcifie d and stenotic conduits. Setting-Two tertiary paediatric cardiology departments. Methods-Sustained (up to five minutes), high pressure (up to 18 atmospheres ), double balloon angioplasty was performed in six calcified and stenotic c ardiac conduits (five consecutive patients, three male, two female, age 4 t o 17 years). Four patients had right ventricle to pulmonary artery (RV-PA) conduits, and one had two venous conduits in a Fontan circulation. Results-Marked reductions in right ventricle to pulmonary artery gradients, from a median (range) of 48 (40 to 62) mm Hg to 11 (5 to 16) mm Hg, and in right ventricle to femoral artery pressure ratios, from a median of 0.8 (0 .72 to 0.86) to 0.4 (0.33 to 0.44), were achieved for all RV-PA conduits. A ll five patients had sustained clinical improvement at follow up (median fo llow up 12 months) and none has required reintervention or surgery. Conclusions-Prolonged high pressure double balloon angioplasty may have a r ole in prolonging the interval between conduit replacements in a subset of patients with complex heart defects.