Balloon pulmonary valvuloplasty in the neonatal period. Clinical and echocardiographic consequences

Objectives. To analyze the efficacy of balloon pulmonary valvuloplasty (BPV ) as the elective treatment for neonatal critical pulmonary valvar stenosis (PVS). Material and methods. The results of clinical and echocardiographic feature s before and after the BPV were reviewed in 29 neonates (18 +/- 12 days of life). Different hemodynamic and 2-D color Doppler echocardiographic were a valuated. The BPV result was classified as favourable if no other balloon o r surgical therapy was required to normalise pulmonary flow and achieve a s ustained right ventricle-pulmonary artery (RV-PA) Doppler gradient below 40 mmHg. It was considered unfavourable if the neonate died, needed surgery o r redilation and/or the RV-PA Doppler gradient was greater than or equal to 40 mmHg. The study developed in three phases: pre BPV immediate post BPV u ntil the hospital discharge (14 +/- 11 days), and in the mid-term followup of between 8 and 96 months (51 +/- 31 months). Results. Mortality was not registered with BPV. The RV/left ventricular sys tolic pressure decreased from 1.4 +/- 0.3 to 0.8 +/- 0.3 (p < 0.01) as a co nsequence of the dilation, and the the systemic oxygen saturation increased from 85 +/- 12 to 92 +/- 6% (p < 0.01). The RV-PA Doppler gradient diminis hed from 86 +/- 18 to 28 +/- 16 mmHg immediately after BPV (p < 0.01) and w as registered at 13 +/- 6 mmHg in the follow-up (n = 24). The RV-PA junctio n Z value grew from -1.25 +/- 0.9 before valvuloplasty to -0.51 +/- 0.7 at the final echocardiogram (p < 0.01). No changes in the tricuspid diameter w ere detected between both periods of time. Five neonates obtained unsatisfa ctory results: 4 in the immediate post BPV (systemic-pulmonary artery shunt 2, transanular patch 2), and 1 in the midterm follow-up (valvectomy + tran sannular patch). The actuarial curve reflects that 82,7% of the patients we re free form reinterventions at 8 years. Conclusions. BPV is safe and effective to relief PVS in the neonate. The ba lloon promotes advantageous changes in both, pulmonary annulus and the righ t ventricle. In addition, the RV-PA Doppler gradient observations in the fo llow-up, support the expectation that the BPV is a <<curative>> therapy.