Hemodynamic findings during exercise on a bicycle ergometer following balloon valvuloplasty of pulmonary stenosis in children and adolescents.

Eleven patients (4 female, 7 male), age range 3.3 to 24.8 years (mean 11.10 years) treated for isolated pulmonary stenosis underwent cardiac catheterization and percutaneous transluminal balloon valvuloplasty (PTVP). The right ventricular systolic pressure (RVSP) before valvuloplasty ranged from 31 to 127 mmHg (mean 79 mmHg) decreasing to 28 to 62 mmHg (mean 42 mmHg) immediately after the dilatation. The peak systolic gradient of the pulmonary valve (delta p RV-PA) before valvuloplasty ranged from 22 to 107 mmHg (mean 61 mmHg) and decreased to a range of 14 and 45 mmHg (mean 23 mmHg) immediately after the dilatation. Balloon valvuloplasty was performed using balloons of 13 to 31 mm in diameter. On 11 patients cardiac catheterization and Doppler echocardiography were repeated between 11 months and 5.3 years (mean 3.11 years) after the balloon valvuloplasty showed a further significant fall in the gradient of pressure. The right ventricular systolic pressure ranged from 20 to 51 mmHg (mean 31.7 mmHg) while the transpulmonary gradient varied from 3 to 24 mmHg (mean 11.6 mmHg). At the time of follow-up examination the patients were aged between 7.2 and 25.7 years (mean 15.9 years). On average the second catheterization was performed 3.11 years following the first hemodynamic study. The follow-up examination encompassed clinical examination, electrocardiogram, Doppler echocardiography, and right heart cardiac catheterization. During right heart cardiac catheterization the children exercised on a bicycle ergometer for three min at 50 or 100 W depending on their body surface area. During this exertion, pressures of the right ventricle and the pulmonary artery as well as heart rate and oxygen saturation were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)     

Predictors of successful pulmonary balloon valvuloplasty: 10-year experience

At our institution, 55 infants and children (ages 0.3–21 yr, median 2.5 yr) underwent pulmonary balloon valvuloplasty between August 1983 and May 1993. Systolic pressure gradients fell acutely following balloon valvuloplasty from 63.5 ± 24.8 mmHg (mean ± standard deviation) to 26.7 ± 12.9 mmHg (P < 0.001) with a decrease in systolic pressure ratio from 0.81 ± 0.25 to 0.42 ± 0.12 (P < 0.0001). Fifty of the 55 patients had long-term echocardiographic evaluation performed >2 yr following balloon valvuloplasty. Thirty-four of the 50 patients (Group A; 68%) were classified as having successful (residual systolic gradients <25 mmHg, ventricular systolic pressure ratios <0.6) long-term outcomes. Their peak systolic gradients fell acutely from 58.8 ± 16.6 mmHg to 22.7 ± 11.2 mmHg (P < 0.001). At 4.6 ± 2.3 yr postvalvuloplasty, peak instantaneous pressure gradients were 17.8 ± 5.7 mmHg (P = ns vs. acute postvalvuloplasty). Fifteen of the 50 patients (Group B; 30%) had unsuccessful (residual systolic gradients ≥25 mmHg and/or ventricular systolic pressure ratios >0.6) long-term outcomes. Their peak instantaneous systolic gradients fell acutely from 76.5 ± 33.1 mmHg to 36.6 ± 11.4 mmHg (P < 0.05). At 3.8 ± 1.7 yr postvalvuloplasty, peak instantaneous pressure gradients were 35.1 ± 9.1 mmHg (P = ns vs. acute postvalvuloplasty). One 3-yr-old patient (Group C, 2%) required repeat balloon valvuloplasty on two separate occasions for recurrent stenosis. There was no significant prevalvuloplasty difference between Groups A and B with regard to age, weight, or Z scores of the pulmonary annull or balloon/annulus ratio; however, patients in Group A had significantly lower prevalvuloplasty gradients and lower systolic pressure ratios than patients in Group B. Total systolic gradient reduction between patients with successful and unsuccessful outcomes was not significantly different (Group A: 36.1 ± 16.6 mmHg; Group B: 41 ± 22.3 mmHg). At long-term follow-up, patients in Group A had fewer symptoms and a significantly lower rate of electrocardiographic right ventricular hypertrophy than Group B patients. Successful outcomes defined by our criteria following balloon valvuloplasty were achieved in 68% of patients with greatest long-term success in patients with prevalvuloplasty systolic gradients <60 mmHg and systolic pressure ratios <0.8. Intervention at lesser systolic gradients (40–60 mmHg) appears indicated to achieve lower long-term gradients and fewer symptoms as total systolic gradient reduction by this technique is limited. © 1996 Wiley-Liss, Inc.     

Pulmonary valvuloplasty in adolescents and adults: 2 year follow-up by continuous Doppler

The purpose of this study is the long term follow-up of the first pulmonary valvuloplasties performed by our group. From september 1984 to march 1988, 10 patients (4 men and 6 women) aged 8 to 58 (mean: 21) with severe or moderate pulmonary valve stenosis underwent pulmonary valvotomy. In all cases the balloon diameter was equal to or 1 mm smaller than the valvular annulus. The results were satisfactory with a significant mean gradient reduction of 51.7%. A follow-up gradient estimation by Doppler echocardiogram was obtained 10 to 37 months after valvuloplasty (mean: 23 months). The mean follow-up gradient by Doppler (31.3 +/- 9.9 mmHg) was not significantly different from the mean hemodynamic post-dilatation gradient (35.6 +/- 14.7 mmHg). A linear correlation was found between the post-dilatation hemodynamic mean gradient and the mean gradient by Doppler follow-up (r = 0.66, p less than 0.05, SEE = 4.1 mmHg). No restenosis were observed. These results suggest that the benefits of valvuloplasty are long lasting. Continuous Doppler is an excellent technique for the follow-up of these patients.     

Balloon aortic valvuloplasty in elderly patients at high risk for surgery, or inoperable: Immediate and mid-term results

Although aortic valve replacement is undoubtedly the treatmentof choice for aortic valve stenosis, balloon aortic valvuloplastymay represent the only possible treatment for some frail elderlypatients who may have additional medical problems. We evaluatedimmediate and 1-year results of balloon aortic valvuloplastyin 86 patients 80 years with severe aortic stenosis. Mean agewas 84±3 years. Forty-four % were 85 years or older.Mean gradient decreased from 68 to 26 mmHg and valve area increasedfrom 0•53 to 0•96 cm² (P<0•05). There weretwo per-procedural deaths. No local vascular complication wasobserved During the follow-up (13±9 months), 27 patientsdied, four had repeat balloon aortic valvuloplasty and eightunderwent aortic valve replacement. Persistent clinical improvementwas observed in 78% of the surviving patients. One-year actuarialsurvival rate was 73%. Balloon aortic valvuloplasty appearsto be a safe and valuable technique in cases where surgery cannotbe performed or carries a very high risk.     

Clinical and Doppler echocardiographic follow-up after percutaneous balloon valvuloplasty for aortic valve stenosis

Percutaneous balloon valvuloplasty has been shown to increase the aortic orifice area and to improve clinical symptoms. However, there are only few data concerning long-term results after balloon valvuloplasty. In this study, 36 patients (11 men, 25 women, mean age 75 +/- 8 years) were followed after balloon valvuloplasty for a period of up to 18 months by means of clinical parameters and repeated Doppler echocardiographic measurements after 1, 3, 6, 12 and 18 months. Invasive measurements revealed a decrease of the systolic peak gradient from 78 +/- 24 to 38 +/- 13 mm Hg (p less than 0.001), and an increase in the aortic orifice area from 0.58 +/- 0.23 to 0.93 +/- 0.2 cm2 (p less than 0.001). The Doppler echocardiographic approach revealed that the maximal instantaneous gradient decreased from 96 +/- 26 to 67 +/- 22 mm Hg (p less than 0.001). The aortic orifice area increased from 0.49 +/- 0.16 to 0.73 +/- 0.21 cm2 (p less than 0.001). Three patients (8%) died in the hospital. After hospital discharge, 16 patients (44%) died and 8 patients (22%) underwent successful aortic valve replacement after a mean follow-up of 8 +/- 6 months. Nine patients (25%) were alive after a follow-up period of 18 months. Seven of these (19%) remained clinically improved. During follow-up, the Doppler echocardiographic results revealed a continuous trend toward the preprocedural severity of the aortic valve stenosis. Progression of restenosis assessed by Doppler echocardiographic measurements was accelerated in the group of patients who subsequently died or underwent repeat balloon valvuloplasty or aortic valve replacement.     

经皮球囊肺动脉瓣扩张术治疗儿童肺动脉瓣狭窄的超声评价

目的 单纯性肺动脉瓣狭窄大多数患者可以接受经皮肺动脉瓣狭窄成形术（PBPV）治疗。我们分析评价PBPV治疗肺动脉瓣狭窄的短期效果。方法 回顾性分析接受PBPV治疗并进行相应的超声心动图随诊的肺动脉瓣狭窄患儿 24 例。结果 接受手术的患儿平均年龄为3.8岁。研究显示：所有患儿均没有手术并发症发生。超声心动图测量肺动脉瓣前向血流峰值压差从PBPV术前80.96±28.06 mmHg下降到术后28.12±12.86 mmHg（P <0.001）。 PBPV手术前后相比肺动脉瓣反流变化无显著的统计学意义。结论 PBPV是治疗儿童单纯肺动脉瓣狭窄的安全有效的治疗方法,长期效果需要进一步更长时间的超声评估。     

Long-term results of percutaneous pulmonary valvuloplasty in adults

We performed percutaneous balloon valvuloplasty of the pulmonaryvalve in 24 patients (aged 17 to 72 years) and in two juvenilepatients. There were no major complications. In almost all thepatients the procedure resulted in a successful pressure gradientreduction from a mean of 92 ± 36 mmHg to 43 ±19 mmHg (P<0·01). In seven patients there was a residualpressure gradient greater than 50 mmHg which, however, decreasedin all patients within the following 3–12 months due toa decrease in subvalvular muscular hypertrophy (from a meanof 70 to 35 mmHg). No restenosis was observed. Only one patient,who had calcified valve leaflets, developed pulmonary insufficiencyand this was of only minor haemodynamic importance. Balloon dilatation of the pulmonary valve can be considereda technique with a high success rate and low complication rateeven in the elderly. Good long-term results support this approachas the first choice in the treatment of pulmonary valve stenosis.     

Management of pediatric patients with isolated valvar aortic stenosis by balloon aortic valvuloplasty

Moderate to severe aortic stenosis in children requires an initial procedure to improve the stenosis and often additional procedures for recurrent stenosis or aortic insufficiency before adulthood. The purpose of this study was to evaluate children who underwent balloon valvuloplasty and were followed with a specific management plan. Twenty-two children with aortic stenosis underwent balloon valvuloplasty and were followed on a regular basis. Repeat valvuloplasty was performed if indicated. The initial gradient was reduced from 63 ± 9 mmHg to 28 ± 8 mmHg (P<0.001). There were no deaths and only one major complication, which had no sequelae. Average follow-up was 61 ± 23 months. Three patients required valve replacement 39–76 months after valvuloplasty for progressive insufficiency. Seven patients underwent successful repeat valvuloplasty. The overall probability of survival without surgical intervention was 75% at 100 months. Balloon valvuloplasty is an effective intermediate palliation for aortic stenosis and is an acceptable alternative to surgical valvotomy. Repeat valvuloplasty is successful without additional risk. In a subgroup of patients, aortic insufficiency is progressive and will require surgical intervention. © 1996 Wiley-Liss, Inc.     

Electrocardiographic Changes Following Balloon Dilatation of Valvar Pulmonic Stenosis

The purpose of this paper was to study the electrocardiographic changes following balloon pulmonary valvuloplasty for pulmonic stenosis and to see if such changes reflect improvement in pulmonary valve gradient following balloon valvuloplasty. Forty-one patients, ages 7 days to 20 years, underwent balloon valvuloplasty for severe valvar pulmonic stenosis. In 35 of these patients ECGs were available 3 to 34 months (mean 11) following valvuloplasty and were compared with pre-valvu-loplasty electrocardiograms. In 30 children with excellent relief of pulmonic stenosis (group I), frontal plane mean QRS vector moved toward the left from 127 ±25° to 81 ±47°as did the horizontal plane mean QRS vector, 88 ± 36° to 27 ±51°. The amplitude of R wave in V_1, 19 ± 11.6 mm, and V₂, 19.7 ± 12.2 mm, decreased respectively to 9.5 ± 5.9 mm and 11.3 ±6.1 mm. S wave amplitude in V₅ and V₆ also decreased. The improvement in the electrocardiogram is associated with a decrease in pulmonary valve gradient from 95 ± 50 to 29 ± 23 mm Hg. In five children with significant residual pulmonary valve gradient (group II), the electrocardiograms did not show any significant change. Evaluation of the time course of ECG changes in group I revealed that recognizable electrocardiographic improvement was first observed at 6 months following successful balloon pulmonary valvuloplasty. Normal electrocardiogram suggests minimal residual pulmonary valve gradient while right ventricular hypertrophy suggests significant residual obstruction unless the electrocardiogram was recorded at or before six months following balloon valvuloplasty. These data suggest that electrocardiogram is a good indicator of improvement following balloon pulmonary valvuloplasty. (J. Interven Cardiol 1988:1:3)     

Percutaneous valvuloplasty of congenital pulmonary stenosis in adults over 50 years of age

The authors report three cases of congenital pulmonary stenosis in adults over 50 years of age treated by percutaneous balloon valvuloplasty. Three symptomatic women aged 74, 80 and 51, had systolic pressure gradients ranging from 107 to 113 mmHg between the right ventricle and pulmonary artery. After valvuloplasty with two balloons or one trefoil balloon, the transvalvular pressure gradient fell to 25 to 30 mmHg. It was only 14 mmHg in one patient controlled after one year's follow-up. The cardiac index was initially decreased and did not change very much immediately after the procedure, increasing from 1.68 1/m2/mn to 1.77 1/m2/mn. The pulmonary valve surface area increased from 0.22 to 0.43 cm2. There were no complications and in one patient, reviewed two years later, the clinical improvement was maintained. Percutaneous valvuloplasty is indicated in severe and/or poorly tolerated pulmonary stenosis. With the 10 other previously reported cases of patients over 50 years of age, the procedure was successful in 12 out of 13 patients (92%). In these patients of 51 to 80 years of age, the systolic pressure gradient between the right ventricle and pulmonary artery was reduced from 112 +/- 46 mmHg to 43 +/- 26 mmHg (-62%). Slight pulmonary regurgitation appeared in 5 out of 9 cases. Valvuloplasty was usually well tolerated and there were no fatalities. There were no signs of restenosis in 5 cases controlled 10 days to 1 year after dilatation. In the future, systematic Doppler echocardiographic examinations should help comparison of cardiac haemodynamics before, immediately after valvuloplasty and at long-term.(ABSTRACT TRUNCATED AT 250 WORDS)     

Balloon valvuloplasty of pulmonary stenosis in infants and children -- Co-operative study of the German Society of Pediatric Cardiology

Balloon valvuloplasty (BVP) of pulmonary stenosis (PST) wasperformed in 305 infants and children in 20 heart centres ofthe Federal Republic of Germany. 273 patients suffered fromisolated PST. Their age ranged from 3 days to 18 years (mean= 5.85 ±4.82 years), their weight from 2.9 to 60 kg.The pressure gradient was measured invasively in the sedatedor anaesthetized child, partly by CW Doppler. BVP was performedby mono- or trefoil catheters, mostly oversized. As a result,mean pressure gradient fell from 71.7±32mmHg before to31.8±25 mmHg immediately after BVP(P< 0.0001). Thegradient was reduced by <30% in 13% of the patients, by 30–49%in 23%, and by 50% in 64%. Among 33 patients with a gradientreduction of <30%, nine were aged <1 year, nine had dysplasticvalves, and nine had a short-term infundibular reaction andgood late results. Gradient reduction was not improved withoversized balloons and was independent of the initial gradient.Follow-up for a mean 11.2±8 months showed a further slightimprovement, probably due to regression of infundibular hypertrophy.In the whole group we observed infundibular reaction in 12%,serious complications with one late death in 4%. From the start,BVP proved to be a secure and effective tool for eliminationof pulmonary stenosis.     

Assessment of accuracy of the Doppler pressure half-time method in the estimation of the mitral valve area immediately after balloon mitral valvuloplasty

AIM: The reliability of Doppler echocardiography in determining themitral valve area after balloon mitral valvuloplasty has beenquestioned, as discrepancies were noted between measurementsobtained by the pressure half-time method and those derivedhaemodynamically, immediately following completion of the procedure.Recent investigations, however, have indicated that these discrepanciesmay be attributable to the over-estimation of the mitral valvearea by haemodynamic measurements, caused by the presence ofthe iatrogenic atrial septal defect complicating transseptalcatheterization. The aim of the present study was to furthertest this hypothesis. METHODS AND RESULTS: Measurements of the mitral valve area by the Doppler pressurehalf-time method and the Gorlin formula were obtained and comparedin 238 consecutive patients before and immediately after retrogradenon-transseptal balloon mitral valvuloplasty, which does notinvolve puncture and/or dilatation of the inter-atrial septum.No significant difference was found between Doppler- and Gorlin-derivedmeasurements, neither before (1·04±0·23vs 1·03±0·23cm², P=ns) nor immediatelyafter (2·14±0·47 vs 2·12±0·49cm², P=ns) valvuloplasty. Linear regression analysis demonstrateda high degree of correlation between Doppler and Gorlin measurementsbefore (r=0·778) and after (r=0·886) the procedure.Good agreement was confirmed by the Bland—Altman method. CONCLUSION: Doppler echocardiography yields accurate measurements of themitral valve area immediately after retrograde non-transseptalballoon mitral valvuloplasty. This finding supports the hypothesisthat the creation of an iatrogenic atrial septal defect duringtransseptal catheterization may contribute to the poor agreementbetween Doppler and Gorlin data after balloon mitral valvuloplasty.     

Resultados a largo plazo de la valvuloplastia transluminal percutánea en la estenosis valvular pulmonar en población pediátrica

Introduction and objectives

Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population.

Methods

The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up.

Results

Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients.

Conclusions

Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results.Full English text available from:www.revespcardiol.org/en     

Results of balloon valvuloplasty in the treatment of congenital valvar pulmonary stenosis in children

Transluminal balloon valvuloplasty was used in the treatment of congenital valvar pulmonary stenosis in 19 children, aged 5 months to 18 years. The right ventricular (RV) systolic pressure and RV outflow tract gradient decreased significantly immediately after the procedure (95 +/- 29 vs 59 +/- 14 mm Hg, p less than 0.01, and 78 +/- 27 vs 38 +/- 13 mm Hg, p less than 0.01). Seven of these patients were evaluated at cardiac catheterization 1 year after balloon valvuloplasty. No significant change occurred in RV systolic pressure or RV outflow tract gradient at follow-up evaluation compared with measurements immediately after balloon valvuloplasty (60 +/- 5 mm Hg vs 56 +/- 12 mm Hg and 39 +/- 5 vs 38 +/- 10 mm Hg). In addition, follow-up evaluation was performed using noninvasive methods and included electrocardiography (n = 13), vectorcardiography (n = 11) and Doppler echocardiography (n = 11) Doppler echocardiography in 11 patients 15 +/- 9 months after balloon valvuloplasty showed a continued beneficial effect with a mild further decrease in RV outflow tract gradient. Thus, balloon valvuloplasty is effective in the relief of pulmonary stenosis.     

Results of balloon valvuloplasty in typical and dysplastic pulmonary valve stenosis: Doppler echocardiographic follow-up

To assess the usefulness of balloon valvuloplasty in patients with a dysplastic pulmonary valve, the files of 36 patients (aged 1 day to 18.5 years) who had two-dimensional echocardiography before and continuous wave Doppler echocardiography late after balloon valvuloplasty (balloon diameter greater than or equal to 20% anulus diameter) were reviewed. Results of relief of pulmonary stenosis were graded by catheter gradient in the catheterization laboratory and compared with Doppler echocardiographic findings at follow-up. There were 32 patients with typical pulmonary stenosis and 4 with a dysplastic valve. In the 32 patients with typical pulmonary stenosis, transvalvular gradient changed from a mean of 67 +/- 32 to 20 +/- 20 mm Hg (p less than 0.0001, mean reduction 72.6%). The gradients at follow-up by Doppler echocardiography averaged 20 mm Hg including 15 that increased, 3 that were unchanged and 14 that decreased. Only 3 (9%) of 32 patients had a gradient greater than 25 mm Hg at follow-up and only one gradient was greater than 35 mm Hg. All four patients with a dysplastic valve had a gradient that decreased with valvuloplasty from a mean of 85 +/- 33 to 33 +/- 20 mm Hg (p less than 0.05); gradient reduction in this group ranged from 40 to 85% (mean 57.5%). The gradient at follow-up increased in three of these four patients and decreased in one (the only late gradient less than 25 mm Hg). Late gradient was less than 35 mm Hg in two of the four patients and was reduced by 43 and 57%, respectively, in the other two.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short- and midterm results of balloon valvuloplasty for valvular aortic stenosis in children.

During a 27-month period, 21 consecutive children (aged 0.1 to 15.7 years) with isolated valvular aortic stenosis underwent percutaneous transfemoral balloon valvuloplasty. Ten children had undergone earlier surgical valvulotomy. The indication for treatment was ST-T-segment changes at rest or during bicycle-ergometry, a continuous-wave Doppler-derived transvalvular gradient greater than 60 mm Hg or syncope, or a combination. Mean peak systolic left ventricular pressure decreased from 165 +/- 19 to 131 +/- 19 mm Hg (p less than 0.001). Mean end-diastolic left ventricular pressure did not change significantly (12 +/- 3 vs 11 +/- 5 mm Hg). Mean peak systolic valve gradient decreased from 71 +/- 23 to 22 +/- 11 mm Hg (p less than 0.001). Mean cardiac index remained unchanged (2.9 +/- 0.8 vs. 3.0 +/- 0.7 liters.min-1.m-2). Aortic valve regurgitation on angiography appeared or increased in 9 patients (up to grade 3 in 3 children). Noninvasive follow-up studies were performed for 2 to 4.2 years (mean 2.8). ST-T changes on the electrocardiogram at rest or during exercise were present in 6 patients before balloon valvuloplasty and had disappeared in all at 6-month follow-up. Reoccurrence of ST-T changes after a longer follow-up was associated with severe valve regurgitation. Syncope was not observed after balloon valvuloplasty. The continuous-wave Doppler gradient decreased from 94 +/- 36 to 49 +/- 15 mm Hg (p less than 0.001). After a follow-up of 2 to 4.2 years (mean 2.8) it remained unchanged (43 +/- 13 mm Hg; p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term results after balloon pulmonary valvuloplasty

BACKGROUND. The objective of this study was to determine the long-term outcome of patients after percutaneous balloon pulmonary valvuloplasty (BPV) treatment of congenital pulmonary valve stenosis. METHODS AND RESULTS. This study represents a case series with duration (mean +/- SD) of follow-up of 4.6 +/- 1.9 years. Forty-six patients with a median age of 4.6 years (range, 3 months to 56 years) had BPV at one academic institution between June 1981 and December 1986. Mean peak systolic pressure gradients from the right ventricle to the pulmonary artery were as follows: before BPV, 70 +/- 36 mm Hg; immediately after BPV, 23 +/- 14 mm Hg; at intermediate follow-up by cardiac catheterization or Doppler echocardiography at less than 2 years after BPV, 23 +/- 16 mm Hg (n = 33); and at long-term follow-up by Doppler at more than 2 years after BPV, 20 +/- 13 mm Hg (n = 42). BPV acutely reduced the gradient to less than 36 mm Hg for 41 of 46 (89%) patients. Available gradients at long-term follow-up were less than 36 mm Hg for 36 of 42 (86%) patients without additional procedures. A patient age of less than 2 years at the initial BPV was a significant risk factor for gradients over 36 mm Hg at follow-up. CONCLUSIONS. BPV provides long-term relief of pulmonary valvular obstruction in the majority of patients. Close follow-up of patients who require BPV at less than 2 years of age is warranted.     

Results of valvuloplasties with balloon catheter in children. Follow-up using pulsed Doppler. Experience with our first cases

Our series includes the first 19 consecutive patients with pulmonary valvar stenosis who underwent balloon valvuloplasty in our hospital. All of them have been evaluated by an echo-Doppler study at different follow-up times, and in 10 patients the study was also performed prior to the dilatation. The ages ranged between 0.4 and 10 years (mean 3.5 years; standard deviation [SD] 2.53 years). The prevalvuloplasty degree of pulmonic stenosis found at catheterization was quantified as severe in 8 cases (42.11%) with a right ventricular systolic pressure (RVSP) in excess of 90 mmHg, and moderate in 11 cases (57.89%) with an RVSP from 70 to 90 mmHg. Transvalvular gradients were registered between 38 and 110 mmHg (m: 69 mmHg and SD: 15 mmHg). According to catheterization data obtained at the time of valvuloplasty, the procedure was considered ineffective in 2 cases (10.52%), scarcely effective in four (21.05%), and successful in the remaining 13 cases (68.42%). Doppler follow-up was carried out between 1.6 and 31.9 months after valvuloplasty (mean 12.9 months and SD: 10 months). Residual stenoses were estimated by Doppler as mild in 13 cases (68.42%), moderate in four (21.05%) and severe in two (10.52%). Mild pulmonary regurgitation was detected in 10 patients (52%). The 13 patients with a satisfactory result had slight residual gradients at the valvular level that had not been modified with the course of time. Of the 4 cases with a poorly effective dilatation the gradients noted by Doppler increased in three of them, being valvular in all but one in whom the obstruction was catalogued as infundibular.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study.

BACKGROUND. Percutaneous balloon valvuloplasty has proven to be acutely effective in the treatment of congenital valvar aortic stenosis; however, the intermediate- and long-term effectiveness of the procedure remain to be documented. METHODS AND RESULTS. To assess the intermediate-term effectiveness of balloon valvuloplasty, repeat catheterization was performed in 27 of 30 children 1.7 +/- 0.1 years after balloon valvuloplasty for congenital aortic stenosis (AS). In 33 children the peak AS gradient was reduced acutely by 55% from 77 +/- 4 to 35 +/- 3 mm Hg (p less than 0.001), and left ventricular systolic pressure was reduced from 176 +/- 4 to 138 +/- 4 mm Hg (p less than 0.001). Despite a technically adequate valvuloplasty procedure, three patients had inadequate relief of obstruction and required complex surgical intervention. Twenty-seven of the 30 patients available for late reevaluation (90%) enrolled in the follow-up study. The peak AS gradient remained significantly reduced compared with that present before valvuloplasty (29 +/- 3 versus 77 +/- 4 mm Hg, p less than 0.001). Furthermore, there was no difference in peak AS gradient at follow-up compared with that immediately after valvuloplasty. The greatest increase in gradient at reevaluation was 14 mm Hg. Twenty of 27 patients (74%) had no change in the degree of aortic insufficiency at follow-up compared with that present before valvuloplasty. At follow-up, 16 patients had no aortic insufficiency at all, and only two had moderate-to-severe (3-4+) insufficiency. Femoral artery injury was documented in four patients, three of whom were under 12 months of age at valvuloplasty. CONCLUSIONS. Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief without early restenosis in children and adolescents with congenital AS.