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.