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.