Balloon pulmonary valvuloplasty for isolated pulmonary valvular stenosis.

Abstract

Fifteen balloon pulmonary valvuloplasties (BPVs) were performed on 13 infants and children with isolated pulmonary valvular stenosis (PVS). There were no complications. Two patients required repeat BPV, one for failure, the other for restenosis. At the time of the 13 latest BPVs, age ranged from three days to 13.1 years (mean 5.7 +/- SD 4.8 years). Average Doppler pulmonary valve pressure gradient preceding BVP was 75 +/- 22 mm Hg. At follow-up it was 25 +/- 9 mm Hg (p < .0001). Follow-up interval was 0.61 to 4.70 years (2.29 +/- 1.18). Restenosis occurred in 1/13 (8%) of the patients. The remaining 12/13 (92%) showed highly satisfactory sustained gradient reductions. Doppler gradients preceding BPV by as much as 4 months correlated highly with catheter gradients at time of BPV, confirming that Doppler echocardiography is a highly accurate indication of PVS severity. Catheterization for PVS should therefore not be used for diagnostic purposes alone. BPV can be performed safely, economically and effectively and is recommended as the treatment of choice for infants and children with moderate to severe isolated PVS. For very young patients, follow-up Doppler surveillance should be done semi-annually; for all others, annually.