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PubMed2001

Long-term results of pulmonary balloon valvulotomy in adult patients.

BACKGROUND AND AIM OF THE STUDY: The study aim was to define the long-term outcome of pulmonary balloon valvulotomy (PBV) in adult patients. METHODS: PBV was performed in 87 patients (46 females, 41 males; mean age 23+/-9 years; range: 15-54 years) with congenital pulmonary valve stenosis (PS). Intermediate follow up catheterization (mean 14.6+/-5.0; range: 6-24 months) was performed after PBV in 53 patients. Clinical and Doppler echocardiography examinations were carried out annually in 82 patients (mean 8.0+/-3.9; range: 2-15 years). RESULTS: There were no immediate or late deaths. The mean catheter peak pulmonary gradient (PG) before and immediately after PBV, and at intermediate follow up was 105+/-39, 34+/-26 (p <0.0001) and 17+/-14 (p <0.0001) mmHg, respectively. The corresponding values for right ventricular (RV) pressure were 125+/-38, 59+/-21 (p <0.0001) and 42+/-12 (p <0.0001) mmHg, respectively. The infundibular gradients immediately after PBV and at intermediate follow up were 31+/-23 and 14+/-9 mmHg (p <0.0001), whilst cardiac index improved from 2.68+/-0.73 to 3.1+/-0.4 l/min/m2 (p <0.05) at intermediate follow up. Doppler PG before PBV and at intermediate and long-term follow up were 91+/-33 (range 36-200) mmHg, 28+/-12 (range 10-60) mmHg (p <0.0001) and 26+/-11 mmHg (p = 0.2), respectively. New pulmonary regurgitation (PR) was noted in 21 patients (25%) after PBV. Five patients (6%) with a suboptimal result (immediate valve gradient > or =30 mmHg) developed restenosis and underwent repeat valvulotomy 6-12 months later using a larger balloon, and with satisfactory outcome. Moderate to severe tricuspid regurgitation (TR) in seven patients regressed after PBV. CONCLUSION: The long-term results of PBV in adults are excellent, with regression of concomitant, severe infundibular stenosis and/or severe TR. Hence, PBV should be considered as the treatment of choice for adult patients with PS.

Adolescent↗
PubMed1988

Balloon angioplasty in congenital heart disease.

Balloon angioplasty and valvuloplasty offer an alternative to surgery in many congenital cardiac conditions and are a useful adjunct in others. To yield optimal results, the most desirable improvement in hemodynamics with the least amount of damage to normal tissue, choice of the catheter should take into consideration the size of the balloon, type of shaft and shape of the balloon. Experience has shown that dilatation is best achieved when the size of the balloon is such that there is a combination of circumferential force, the stress exerted when the balloon is near its maximal diameter, and longitudinal force, the extent of which is directly proportional to the deformity of the balloon. If the balloon is too small, little benefit may be accrued from the procedure; if it is too large, there is a risk of danger to adjacent normal structures. A stiff shaft helps to maintain a stable position during inflation and the size of the shaft determines the caliber of the guidewire lumen and the inflation/deflation lumen. A single, circular balloon has the advantage of distributing the dilating forces uniformly during inflation; more recently introduced alternative designs with two or three balloons mounted around the shaft have the advantage of allowing some blood flow to occur even at full inflation but they also have the theoretical disadvantage of not ensuring an even distribution of circumferential force. Dilatation of pulmonary valve stenosis may be considered indicated in the presence of a pressure gradient of 40 mm Hg with a right ventricular pressure of 60 mm Hg as the lower limit. In the newborn, this may be qualified by setting the lower limit of right ventricular pressure as 10 mm Hg below systemic arterial pressure if that is 60 mm Hg or less. On choice of the proper balloon size, approximately 20 to 30 percent greater than the pulmonary root, success may be expected in 90% of the cases and, in general, the initial result appears to be that which persists. Although Doppler echocardiography frequently shows pulmonary regurgitation, this is rarely clinically evident. The procedure is safe and only few complications have been reported. Establishing the indication for aortic valvuloplasty usually requires the presence of a systolic gradient of 60 mm Hg without severe regurgitation; mild aortic regurgitation is not a contraindication to the procedure. Reports have indicated good results in both infants and children. This procedure is not without risk and deaths have been reported.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1992

Indications and outcome of valvuloplasty.

Balloon valvuloplasty is widely practiced, but its result depends on the pathology considered. Percutaneous mitral balloon valvuloplasty evolved from the earlier development of percutaneous balloon valvotomy of the pulmonic valve into an effective method for the treatment of patients with mitral stenosis. Percutaneous aortic balloon valvotomy has been used as an alternative to aortic valve replacement in elderly patients with degenerative calcific aortic stenosis, but immediate results are suboptimal and the short-term rate of restenosis is high. In congenital pulmonary valve stenosis, balloon valvotomy produces a dramatic relief of the pressure gradient with excellent long-term follow-up results.

Aortic Valve Stenosis↗