Balloon valvuloplasty for congenital heart disease: Immediate and long-term results of multi-institutional study

BACKGROUND AND OBJECTIVES: Several studies have been reported in Japan. However, the reports consist of small series at individual institutions. We evaluated the immediate to long-term results of balloon valvuloplasty (BVP) of congenital pulmonary and aortic stenosis at multi-institutions in Japan. METHODS AND RESULTS: Immediate and follow-up data were obtained from eight institutions in Japan. In our series of 172 cases of pulmonary valvuloplasty excluding critical pulmonary stenosis, the mean pressure gradient decreased immediately after BVP from 61+/-27 mmHg to 28+/-20 mmHg and the reduced gradient continued at follow-up in most cases. The BVP for critical pulmonary stenosis could be accomplished in 35 of 39 patients. The mean right ventricular systolic pressure decreased from 102+/-29 mmHg to 62+/-23 mmHg. One of them required the surgical operation for perforation of the right ventricular outflow tract. In BVP for congenital aortic valvular stenosis of 77 cases excluding critical aortic stenosis, the mean pressure gradient decreased immediately after BVP from 68+/-24 mmHg to 34+/-23 mmHg. Thirty-one cases (55%) were free from any interventions in long-term follow-up. The BVP for critical aortic stenosis was performed in 29 neonates. The overall mortality rate was 34% and 24% of the patients required repeat intervention. The remaining 42% was free from any interventions. CONCLUSIONS: Balloon valvuloplasty for congenital pulmonary valvular stenosis is a safe and effective procedure and the initial treatment of choice. In spite of an occasional major complication, BVP for critical pulmonary stenosis is effective in many infants. Balloon aortic valvuloplasty is palliative. However, this procedure has the efficacy in deferring the surgical intervention. Balloon valvuloplasty for neonatal critical aortic stenosis is a useful method to recover from serious conditions.