Balloon valvuloplasty for valvular pulmonary stenosis in children over 6 months of age: initial results and long-term follow-up

Between 1984 and December 1990 balloon valvuloplasty for valvularpulmonary stenosis was planned and performed in 92 childrenover 6 months of age (range 0.8–17.9 years). Valvuloplastydecreased the invasively determined peak systolic gradient from61±34 (mean±SD) to 27±20 mmHg (P <0.0001At follow-up cardiac catheterization, performed in 22 patientsafter 13±5 months, the gradient was 22±23 mmHg(ns). Initially the continuous wave Doppler gradient decreasedfrom 61±23 to 26±12 mmHg (P <0.0001). It thenremained unchanged both at early follow-up after 0.6±0.3years, being 23±12 mmHg and at long-term follow-up after3±1.7 years (21±10 mmHg, ns). In the 41 patientstreated before the end of 1986 the residual continuous waveDoppler gradient at long-term follow-up after 5.1±0.8years was 21 ± 10 mmHg. Mild pulmonary regurgitationwas present in 77% of the patients at early follow-up and in83% at the last follow-up. Right ventricular hypertrophy onthe electrocardiogram was present in 83% of the children beforevalvuloplasty. At early follow-up it had decreased to 44% withafurther decrease to 24% at the last follow-up. Comparison of patients with initial invasive systolic gradientsgreater and smaller than 50 mmHg revealed no differences betweeneither group with regard to the continuous wave Doppler gradientat last follow-up, the incidence of pulmonary regurgitationand the occurrence of significant complications. Pulmonary balloon valvuloplasty can be safely and successfullyperformed in children over 6 months of age. Restenosis is rareand the relief of the gradient persists in the long-term. Pulmonaryregurgitation remains mild. The electrocardiogram is of littlevalue in the follow-up of these patients.