M. Jarrar et al., Long-term invasive and noninvasive results of percutaneous balloon pulmonary valvuloplasty in children, adolescents, and adults, AM HEART J, 138(5), 1999, pp. 950-954
Citations number
31
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background Short-term and mid-term results of percutaneous balloon pulmonar
y valvuloplasty (BPV) are well known. However, data documenting long-term e
ffectiveness of BPV are scarce.
Methods and Results The long-term results of 62 patients were assessed by c
atheterization and Doppler echocardiography 1 to 10 years(mean 6.4 +/- 3.4)
after BPV. Mean age of the patients was 13.5 +/- 10.5 years (range 9 month
s to 44 years). Twenty patients were 16 years of age or older. Right ventri
cular peak systolic pressure was systemic or suprasystemic in 72% of patien
ts. A double-balloon technique was used in 29 patients. The balloon-to-pulm
onary valve diameter ratio was 1.4 +/- 0.38 (range 1 to 1.8). Total systoli
c transpulmonary pressure gradient in excess of 50 mm Hg in all patients be
fore BPV decreased from 98 +/- 40 to 32 +/- 23 immediately after BPV and to
19 +/- 9 mm Hg at follow-up (P < .001). Infundibular gradient increased fr
om 8 +/- 10 to 14 +/- 24 mm Hg after BPV and fell to 1 +/- 4 mm Hg at follo
w-vp (P < .01). in 16 patients it was greater than or equal to 20 mm Hg and
virtually disappeared spontaneously in all at follow-up. The valvar gradie
nt fell from 93 +/- 39 to 19 +/- 11 (P < .001) and was 1 8 rt 9 mm Hg at Fo
llow-up. it remained unchanged in 3 patients (range 36 to 45 mm Hg). in 3 (
4.8%) other patients, a new gradient >35 mm Hg developed that was greater t
han or equal to 50 mm Hg in all 3. Among 5 patients having dysplastic valve
s, 3 had a gradient >35 mm Hg. There were no predictors of a gradient >35 m
m Hg at longterm follow-up by univariate or multivariate Cox proportional h
azards analysis. Mild to moderate pulmonary regurgitation was present in 39
% of patients. On electrocardiography, right ventricular hypertrophy decrea
sed significantly in 90% of patients.
Conclusions BPV as a treatment of typical pulmonic valve stenosis produces
excellent long-term results. Restenosis is rare (4.8%) and occurs more freq
uently in patients with dysplastic valves. There is a constant spontaneous
regression of associated infundibular obstruction.