Immediate and Short-Term Results of Balloon Pulmonary Valvuloplasty from Neonates to Grown Up Children with Critical Pulmonary Stenosis: Experience from a Tertiary Care Centre in Bangladesh

Abstract

Background: Although neonates present with critical pulmonary stenosis (PS) it is equally found in grown up children in developing country like Bangladesh. Balloon pulmonary valvuloplasty (BPV) is one of the most common catheter- based intervention. Transcatheter interventions in critical PS present unique challenges in Bangladesh due to unavailability of expert centre & hardware, cost of procedure, low weight and delayed diagnosis. Careful technique, proper planning & safety measures reduces the incidence of complications. Objective: The study was undertaken to find out the immediate & mid-term outcome of critically ill neonates, infants, children, adolescent who needed emergency pulmonary valvuloplasty for critical PS. Methods: This retrospective study was conducted in the cardiac centre of Bangladesh Shishu Hospital & Institute between June 2014 to June 2022. Percutaneous balloon pulmonary valvuloplasty done in 54 children having critical stenosis or membranous pulmonary atresia.  Clinical parameters, SPO2, echocardiographic data, cathlab data & outcome were recorded. Statistical analysis was done by using SPSS version 24. Results: Among these neonates were 6(11.8%), infants between 1 month to one year was 30(58.8%), from 1 year to 5 years 10(19.6%), more than 5 years 5(9.8%). Median weight was 6.5 kg; lowest weight was 1.96 kg. The peak systolic gradient reduced from an average of 66 ± 7 mm Hg to 16.5 ± 5 mm Hg (P value <0.05). No major complication occurred except mild PR, RV dysfunction, transient bradycardia. Two patients died due to sudden cardiac arrest after six hours of procedure. At 1 month follow up 12 patients had mild residual stenosis, 5 had moderate residual pulmonary stenosis and 2 had severe residual pulmonary stenosis. At 6 month follow up four patients had mild residual pulmonary stenosis & one had moderate pulmonary stenosis. Conclusion: Balloon pulmonary valvuloplasty appears feasible, effective and relatively safe initial management & having encouraging immediate & short term results of critical pulmonary valve stenosis in the neonate to grown up children.