Percutaneous balloon valvuloplasty for congenital pulmonary valve stenosis in adults.

BACKGROUND: Although pulmonary valvular stenosis is not uncommon in adults, there are few reports of percutaneous pulmonary valvuloplasty in adults, despite the possibility of avoiding heart surgery. AIM: This report describes the experience in adult patients undergoing this procedure and evaluates its effectiveness and tolerance. METHODS: Over an 8-year period (1989-1997), pulmonary valvuloplasty was considered in 22 adult patients [8 men, 14 women; mean age 28.0 years +/- standard deviation (SD) 10.3; range 16-46 years] with congenital pulmonary valve stenosis. Sixteen patients were asymptomatic with pulmonary systolic murmurs, although 6 patients presented with dyspnea. Before the procedure, the mean transpulmonary valve gradient was 53.2 +/- 24.8 mmHg SD, with a mean right ventricular systolic pressure of 74.6 +/- 28.4 mmHg SD, and mean pulmonary artery pressure was 21.4 +/- 6.4/10.2 +/-3.9 mmHg. RESULTS: The procedure was successful in 19 patients (6 men, 13 women) and was well tolerated and free of complications. Following the procedure, the mean transvalvular gradient was 15.5 +/- 11.5 mmHg, with a mean right ventricular systolic pressure of 40.5 +/- 13.6 mmHg and a mean pulmonary systolic pressure of 24.3 +/- 7.4 mmHg. This represented mean fall in transpulmonary valve gradient of 42.4 +/- 22.0 mmHg (paired t-test, p < 0.0001). After a mean follow-up of 20.1 months (13.4 SD), most patients remained well and asymptomatic, although two patients required repeat valvuloplasty. CONCLUSION: Pulmonary valvuloplasty is a well tolerated and effective treatment for pulmonary valve stenosis in adults, with few complications and no need for surgery. This procedure should be considered as the primary treatment of adult patients with pulmonary valve stenosis.     

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)     

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.     

Balloon catheter dilation of severe pulmonary restenosis 11 years after surgical valvulotomy

A young girl who underwent repair of an atrial septal defect and pulmonary valvulotomy when 6 years of age, presented with clinical and haemodynamic signs of pulmonary restenosis 11 years later: right ventricular systolic pressure (RVSP) of 130 mmHg with a systolic RV/PA pressure gradient of 105 mmHg. Pulmonary valvuloplasty was performed using a balloon catheter (20 mm X 40 mm). Two inflations were necessary to correct the hour glass deformity of the balloon caused by the stenosis. After valvuloplasty the RVSP was 75 mmHg and the RV/PA gradient 55 mmHg. The calculated pulmonary valve surface area increased from 0.36 cm2 to 0.72 cm2. Angiography performed immediately after dilatation showed improved valvular mobility but here was persistant severe infundibular hypertrophy. The intensity of the pulmonary systolic murmur decreased. The good result obtained in this case shows that percutaneous valvuloplasty may be considered when restenosis occurs several years after surgical valvulotomy. Control catheterisation performed two months after dilatation confirmed the good initial haemodynamic result.     

Balloon pulmonary valvuloplasty after initial pulmonary valvotomy for pulmonary atresia with intact ventricular septum]

Seven patients with pulmonary atresia and intact ventricular septum have undergone closed pulmonary valvotomy on the early neonatal period (2-6 days) with satisfactory results. Follow-up catheterization showed significant residual pulmonary valve stenosis requiring a second operation. Percutaneous balloon dilatation of the pulmonary valve was successful in 6 cases with the mean right ventricular systolic pressure reduced from 6.8 to 4.9 kPa (50.8 to 37 mmHg) and the mean transvalvular gradient dropped from 5.7 to 2.1 kPa (4.28 to 15.8 mmHg). One case failed and required surgical treatment. The results showed that balloon valvuloplasty could be applied instead of surgery for treatment of selected cases of pulmonary atresia with intact ventricular septum after an initial pulmonary valvotomy.     

Balloon dilatation for critical pulmonary stenosis.

This study was conducted to investigate the outcome of balloon valvuloplasty for critical pulmonary stenosis in young infants. During a 6.2-year period between January 1992 and February 1998, 34 infants with critical pulmonary stenosis, aged 1 to 58 days (16.8+/-16.6 days), underwent attempted balloon valvuloplasty in this institution. The procedure was accomplished in 28 patients, but failed in six. Surgical pulmonary valvotomy was performed in the six patients with one mortality. Immediately following valvuloplasty, the mean right ventricular systolic pressure decreased from 109.2+/-28.6 to 55.1+/-23.6 mm Hg in the 28 patients (P<0.01). The mean pressure gradient decreased from 85.6+/-29.4 to 26+/-21.4 mm Hg (P<0.01). However, one who had a severely hypoplastic right ventricle requiring prolonged prostaglandin E1 infusion after valvuloplasty underwent a right ventricular outflow tract patch. After a follow-up period ranging from 2 months to 6.4 years (30.5+/-19.1 months), one patient developed recurrent pulmonary stenosis and underwent a repeated balloon valvuloplasty. Of the 27 patients (79%) with a definitive success of balloon valvuloplasty, the mean pressure gradient estimated with Doppler echocardiography at most recent follow-up was 15.2+/-6.8 mm Hg. Therefore, balloon valvuloplasty is the procedure-of-choice for critical pulmonary stenosis. Surgery should be reserved for those with unsuccessful balloon valvuloplasty.     

Late Results of Pulmonary Balloon Valvuloplasty in Adults Using Double Balloon Technique

Between July 1985 and July 1987, 18 consecutive adult patients with congenital pulmonary stenosis underwent pulmonary balloon valvuloplasty (PBV). There were 11 males and 7 females, aged 15–45 years (mean 25). A double balloon technique was used in 14 patients and a single balloon in four. The size of the balloon used was 0.9 to 1.4 times the size of the pulmonary annulus. Eleven patients were restudied by repeat cardiac catheterization 6 months later. Student's t-test was used for comparison of data. Right ventricular (R V) systolic pressure before dilatation ranged from 84 to 180 (mean 123 ± 28.3) mmHg and the right ventricular to pulmonary artery (PA) peak systolic gradient ranged from 60 to 165 (mean 105 ± 30.2) mmHg. Immediately after dilatation, the RVsystolic pressure dropped to 30–80 (mean 53 ± 14.2) mmHg (P < 0.001). RV to PA peak systolic gradient dropped to 10–57 (mean 32 ± 14.2) mmHg (P < 0.001). A restudy of 11 patients 6 months later showed a further drop of RV systolic pressure to 35–65 (mean 49 ± 11.3) mmHg (P < 0.05). RV to PA peak systolic gradient continued to drop to 10–48 (mean 26 ± 11.3) mmHg (P < 0.01). Cardiac index improved from 2.68 ± 0.73 to 3.03 ± 0.40 L/min/m², P < 0.05. No complication was noted apart from either sinus bradycardia or extrasystole in a few patients. It was noted that balloon to annulus ratios of 1.1 to 1.4 produced sustained relief of the pulmonary valve stenosis. We concluded that PBV is the treatment of choice for congenital pulmonary stenosis. It reduced the hospital stay to 2 days and avoids the ri±k of open heart surgery. (J Interven Cardiol 1988:1:1)     

Intermediate-term results of balloon valvuloplasty for isolated and complicated pulmonary valve stenosis.

The purpose of this study is to report our experience regarding the acute and intermediate-term results of balloon pulmonary valvuloplasty (BPV) in various types of congenital pulmonary valve stenosis. Methods and Results: Twenty-four consecutive patients with a median age of 6.6 years (ranging from 1 month to 24 years old) underwent BPV between January 1988 and September 1991. These patients were divided into 2 groups; Group 1 consisting of 13 patients with isolated pulmonary valve stenosis, and Group 2 consisting of 11 patients with complicated pulmonary valve stenosis (supravalvular, subvalvular, valved conduit and post-right ventricular outflow reconstruction). Mean peak systolic pressure gradients from the right ventricle to the pulmonary artery were as follows: In group 1, 48 +/- 21 (mean +/- SD) mmHg before BPV, 18 +/- 8 mmHg immediately after BPV and 13 +/- 5 mmHg at the longest follow-up based on catheterization or Doppler echocardiographic studies. The gradients in group 2 were 65 +/- 28 mmHg before BPV, 46 +/- 25 mmHg immediately after BPV and 47 +/- 21 mmHg at the longest follow-up. Conclusions: BPV provides both acute and intermediate-term gradient relief in patients with isolated pulmonary valve stenosis. In complicated pulmonary valve stenosis, on the other hand, the effect of BPV was unsatisfactory and appears to depend on the mechanism of associated obstruction. Therefore accurate evaluation of the anatomy of associated obstruction in the pulmonary valve region is needed to determine that BPV is indicated.     

Angioplasty and percutaneous valvuloplasty in congenital and acquired cardiopathies. Short- and long-term results

Percutaneous transluminal balloon catheterization was performed in 38 patients, age 2 to 38 years (mean 13) between October, 1985 and May, 1987. Nineteen with pulmonary valve stenosis (PVS), three with small atrial septal defect (ASD) and one with ventricular septal defect (VSD); six with aortic valve stenosis (AVS); eight with Coarctation of the aorta (CoAo), in two with VSD and one with small ductus arteriosus; and four with rheumatic mitral stenosis (RMS). In PVS the peak systolic gradient (PSG) decreased significantly immediately after the procedure (92 +/- 40 vs 20 +/- 19 mmHg P less than 0.01). Nine patients were evaluated three months and seven one year later and no significant change occurred (19 +/- 11 and 20 +/- 19 mm Hg). The right ventricular systolic pressure (RVSP) and the ratio RVSP/left ventricular systolic pressure (LVSP) decreased immediately after the procedure (114 +/- 37 vs 69 +/- 36 mmHg P less than 0.15, and 0.98 +/- 0.29 vs 0.62 +/- 0.36, P less than 0.15). Three months later the RVSP and ratio RVSP/LVSP decreased more (57 +/- 16 mmHg, P less than 0.05, and 0.47 +/- 0.18, P less than 0.05) and one year later (54 +/- 27 mm Hg, P less than 0.05 and 0.46 +/- 0.24, P less than 0.05). In one case we repeated de dilatation one year later for restenosis. In CoAo PSG decreased immediately after dilation (59 +/- 21 vs 26 +/- 18 mmHg, P less than 0.1). Three months later the gradient was 38 +/- 20 mmHg. One patient was sent to surgery for significant residual gradient and one was dilated again 4 months after the first dilatation. One case was evaluated at cardiac catheterization one year later with gradient of 28 mmHg and blood pressure and femoral pulses were normal. In AVS PSG decrease immediately in all (91 +/- 25 vs 37 +/- 22 mmHg, P less than 0.02). Recatheterization in 4 patients three months later showed improvement in two. Two cases were sent to surgery for significant residual gradient. In these two patients we did not performed a dilatation because one had thrombosis in the puncture site and in the other we suspect subvalvular obstruction. The other two patients have shown clinical, echocardiographic and radiographic improvement.(ABSTRACT TRUNCATED AT 400 WORDS)     

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)     

Percutaneous balloon valvuloplasty for treatment of congenital pulmonary valvular stenosis in children

Percutaneous balloon pulmonary valvuloplasty was performed in seven children with moderate to severe valvular pulmonary stenosis (right ventricular to pulmonary artery pressure gradient greater than 50 mm Hg). All patients experienced a decrease in right ventricular peak systolic pressure from 108 +/- 30 to 60 +/- 5.6 mm Hg (p less than 0.001), decrease in right ventricular to pulmonary artery gradient from 90.1 +/- 30 to 38.8 +/- 5 mm Hg (p less than 0.001) and increase in pulmonary valve area from 0.33 +/- 0.06 to 0.55 +/- 0.15 cm2/m2 (p less than 0.001). In the two patients who underwent supine bicycle exercise before and after valvuloplasty, a significant decrease in both the maximal right ventricular peak systolic pressure (212 to 140 and 175 to 125 mm Hg, respectively) and in right ventricular to pulmonary artery peak pressure gradient (185 to 110 and 151 to 85 mm Hg, respectively) occurred. All patients tolerated the procedure well and no serious complications were observed. It is concluded that percutaneous balloon valvuloplasty is a safe and effective method for relief of right ventricular obstruction due to moderate or severe valvular pulmonary stenosis. However, long-term results remain unknown.     

Pulmonary valvuloplasty. Long term results at the Centro Medico la Raza]

The purpose of this study was to evaluate the immediate and long term results of pulmonary valve ballon dilation, and to determine the prognostic factors of failure in 109 patients (60 female and 49 male), aged 7.04 +/- 8.4 years. Seventy two patients (66.1%) had isolated valvular stenosis and 33.9% presented associated lesions. Peak systolic pressure gradient across the pulmonary valve decreased from 89.53 +/- 37.23 to 20.8 +/- 19.41 mmHg (p < 0.0001) after valvuloplasty. Forty three patients developed reactive infundibular stenosis after valvuloplasty with a systolic gradient of 19.65 +/- 35.64 mmHg. At a mean period of 8 years of follow-up the pressure gradient was 20.75 +/- 14.32 (p < 0.001). Valvuloplasty was successful in 86.2% of the cases with a global mortality of 1.9%, minor complications in 15.2%, and a failure rate of 13.8%. At follow-up restenosis developed in 6.7%. The comparative analysis between the groups of success and failure yield as significant risk factors for failure an age younger than 3.5 years and a pulmonary valve with displastic (p < 0.05) or combined morphology (p < 0.05). This group had also more complications and higher systolic gradients and right ventricular pressures post-dilation (p < 0.05). Pulmonary valvuloplasty is a safe and effective procedure for the treatment of pulmonary valve stenosis with a good immediate and long-term results, and is now considered the treatment of choice.     

Percutaneous pulmonary valvuloplasty in adults

Percutaneous balloon pulmonary valvuloplasty was performed in 6 adult patients (aged 21-59 years, mean age: 43 years) with congenital pulmonary valve stenosis and systolic pressure gradients of 50 to 120 mm Hg (mean: 78 mm Hg). In 5 patients the procedure was successful: mean systolic right ventricular pressure was reduced from 99 +/- 26 to 55 +/- 7 mm Hg and the trans-stenotic pressure gradient from 77 +/- 28 to 31 +/- 12 mm Hg. Valvuloplasty with a 20 mm balloon was not effective in a patient with a wide pulmonary anulus (diameter 25 mm). In 1 patient only, the balloon occlusion led to severe systemic hypotension with syncope. Short-term follow-up (3 months) demonstrated symptomatic improvement and persistent reduction of the pressure gradient in all successfully treated patients. In conclusion, percutaneous balloon pulmonary valvuloplasty appears to be an effective method with low risk of complications for the treatment of pulmonary valve stenosis in adults.     

Percutaneous transluminal balloon pulmonary valvoplasty--long-term results

Thirty-two patients with isolated valvar pulmonary stenosis (21 male; 11 female, age range 4 to 53 years, mean 14 years) underwent cardiac catheterization and balloon valvoplasty. Right ventricular systolic pressure before valvoplasty ranged from 65 to 210 mm Hg (mean 120.2 +/- 44.8 mm Hg). It fell to 24-200 mm Hg (mean 73.1 +/- 42.4 mm Hg) immediately after dilation. Peak systolic gradient across the pulmonary valve before valvoplasty ranged from 42 to 193 mm Hg (mean 98 +/- 45.3 mm Hg) and decreased significantly to 5 to 182 mm Hg (mean 52.7 +/- 43.1 mm Hg) immediately after dilation. At repeat cardiac catheterization in 21 patients 3 to 6 months after valvoplasty, a further significant fall of gradient was noted in 15 patients with no change in the remaining six patients. The right ventricular systolic pressure ranged from 30 to 100 mm Hg (mean 55.1 +/- 21.8 mm Hg) while the transpulmonary gradient varied from 12 to 84 mm Hg (mean 34 +/- 23.8 mm Hg). In the four patients evaluated 1 to 1 1/2 years after valvoplasty, the gradient further reduced in 2 patients and was unchanged in the remaining two patients. Patients with isolated valvar pulmonary stenosis can be adequately and safely treated with balloon valvoplasty, without recourse to surgery with excellent immediate and long-term results.     

Percutaneous transluminal valvuloplasty of pulmonary stenoses. Apropos of 35 cases

Thirty-five patients with moderate or severe valvular pulmonary stenosis underwent percutaneous transluminal valvuloplasty (PTV). The average age of the patients was 12 years (range 4 to 34 years). Sixty per cent were under the age of 10, 20 p. 100 were between 10 and 17 years old and 20 p. 100 between 18 and 34 years old. Systolic right ventricular pressures were greater than the pressures in the systemic circulation in 22 cases. The right ventricular-pulmonary artery pressure gradient was greater than 50 mmHg in 29 patients and less than or equal to 50 mmHg in the other 6 patients. The diameter of the balloon of the dilation catheter varied from 12 to 20 mm in 31 PTV; in the other 4 cases two dilating catheters were used simultaneously to dilate the pulmonary valves. The tolerance of PTV was generally good and the results were satisfactory: right ventricular pressures (RVP) fell from 140 +/- 45 to 77 +/- 25 mmHg (p less than 0.001); the RV-PA pressure gradient fell from 82 +/- 40 to 32.4 +/- 15 mmHg (p less than 0.001) and the ratio of RVP to systemic pressure from 1.2 +/- 0.4 to 0.65 +/- 0.2 (p less than 0.01). Clinical and haemodynamic reevaluation in 19 patients 4 to 16 months after PTV (mean 8.5 +/- 2 months) showed that RVP, RV-PA pressure gradients and RVP/systemic pressure ratios had significantly decreased respectively from 78 +/- 30 to 52 +/- 14 mmHg (p less than 0.001), from 27.7 +/- 7.7 to 21.8 +/- 7.3 mmHg (p less than 0.02) and from 0.6 +/- 0.2 to 0.4 +/- 0.1 (p less than 0.001). Pulmonary valvuloplasty is well tolerated, safe and may reduce the number of patients requiring surgical valvotomy.     

Balloon pulmonary valvuloplasty in the management of cyanotic congenital heart defects.

Twenty-three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 +/- 8% (mean +/- SD) vs. 94 +/- 5%, P less than 0.001] and pulmonary-to-systemic flow ratio (0.7 +/- 0.1 vs. 1.0 +/- 0.2, P less than 0.001). Peak systolic pressure gradient across the pulmonary valve decreased (P less than 0.001) from 105 +/- 48 to 25 +/- 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 +/- 13 vs. 83 +/- 13%, P less than 0.01) and pulmonary-to-systemic flow ratio (0.7 +/- 0.4 vs. 1.2 +/- 0.5, P less than 0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pulmonic valve (52 +/- 16 vs. 32 +/- 22 mm Hg, P less than 0.05) decreased while infundibular and total pulmonary outflow tract gradients were unchanged (P greater than 0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow-up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary-to-systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)     

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.     

Balloon dilatation for discrete subaortic stenosis: immediate and intermediate-term results

Six children with subvalvar aortic stenosis underwent percutaneous balloon angioplasty over a 15-month-period ending October 1989. The mean systolic pressure gradient across the left ventricular outflow tract decreased from 56 +/- 19 (mean +/- SD) to 12 +/- 7 mmHg (p less than 0.001) immediately following valvuloplasty and the degree of aortic insufficiency did not significantly increase. Follow-up Doppler data (in all 6 patients) were available 3 to 16 months (mean, 11 months) after angioplasty and revealed a residual aortic subvalvar gradient of 21 +/- 5 mmHg, which continues to be significantly lower (p less than 0.001) than that prior to angioplasty. There was no increase in aortic insufficiency. The single infant with increase in gradient at followup was determined to have fibromuscular, tunnel type of subaortic obstruction. None of the five patients with discrete membranous obstruction had significantly increased their gradients. Use of balloons larger than aortic valve anulus did not produce any adverse effect, particularly aortic insufficiency. We surmise that the immediate and intermediate-term follow-up results of balloon angioplasty are encouraging and balloon angioplasty should be considered as a treatment option in the initial management of discrete subaortic membranous stenosis.     

Percutaneous transluminal balloon valvuloplasty for pulmonary valve stenosis

Transluminal balloon valvuloplasty was used to treat congenital pulmonary valve stenosis in 20 patients. Follow-up cardiac catheterization was performed in 11 patients at intervals of from 2 to 12 months after the procedure. Peak systolic pressure gradient across the pulmonic valve decreased from 68 +/- 27 to 23 +/- 5 mm Hg (p less than .001) after valvuloplasty. There were no complications. Follow-up catheterization demonstrated persistent relief of right ventricular hypertension in the patients with typical pulmonary valve stenosis.     

Balloon valvuloplasty for pulmonary valvular stenosis: a long-term follow-up study using pulsed Doppler echocardiography

From June 1984 to March 1987, percutaneous balloon valvuloplasty (PBV) was performed for 22 patients with congenital pulmonary valvular stenosis. It was successful for 20 patients, and there were significant decreases of transvalvular pressure gradients; 72 +/- 30 mmHg before PBV, and 30 +/- 12 mmHg immediately after PBV (p less than 0.001). In a follow-up study, pulsed Doppler echocardiography and cardiac catheterization were used to examine changes in long-term hemodynamic findings after PBV. One year follow-up evaluation was performed for 14 patients, and two year follow-ups for seven patients. One year after PBV the transvalvular pressure gradients were evaluated during cardiac catheterization in 11 patients, and using pulsed Doppler echocardiography in the remaining three patients. The gradients of the seven patients at two year intervals after PBV were evaluated using pulsed Doppler echocardiography. The pressure gradients of two patients improved further one year later due to the anatomical degradation in the right ventricular outflow tracts. For seven patients, two year follow-up evaluations were performed, and the transvalvular pressure gradient reduced from 84 +/- 23 to 33 +/- 15 mmHg (p less than 0.001) immediately afterwards; to 27 +/- 22 mmHg (p less than 0.01) one year later; and further to 12 +/- 5 mmHg (p less than 0.001) two years after PBV. Second PBV was performed for three patients in whom a residual gradient was recognized, with the good results. On auscultation, a pulmonary regurgitant murmur was recognized in 28% of 18 patients immediately after PBV, but 80% of this resolved one year later. Two patients had pulmonary regurgitation with pulmonary valvular stenosis before PBV.(ABSTRACT TRUNCATED AT 250 WORDS)