Balloon valvuloplasty of pulmonary stenosis in infants and children — Co-operative study of the German Society of Pediatric Cardiology

Abstract

Balloon valvuloplasty (BVP) of pulmonary stenosis (PST) was performed in 305 infants and children in 20 heart centres of the Federal Republic of Germany. 273 patients suffered from isolated 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 sedated or anaesthetized child, partly by CW Doppler. BVP was performed by mono- or trefoil catheters, mostly oversized. As a result, mean pressure gradient fell from 71.7 +/- 32 mmHg before to 31.8 +/- 25 mmHg immediately after BVP (P less than 0.0001). The gradient was reduced by less than 30% in 13% of the patients, by 30-49% in 23%, and by greater than or equal to 50% in 64%. Among 33 patients with a gradient reduction of less than 30%, nine were aged less than 1 year, nine had dysplastic valves, and nine had a short-term infundibular reaction and good late results. Gradient reduction was not improved with oversized balloons and was independent of the initial gradient. Follow-up for a mean 11.2 +/- 8 months showed a further slight improvement, 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 elimination of pulmonary stenosis.

Pulmonary stenosis in complicated monochorionic twin pregnancies: prevalence, management and outcome

“…If one considers only liveborns, the neonatal survival rate was 95% (19/20). In cases mandating surgical treatment, BPV proved to be the procedure of choice, with a high success rate (11/13, 84.62%), as previously demonstrated in literature …”

Long-term results after balloon pulmonary valvuloplasty.

“…Progression of residual gradients has been documented to occur infrequently at intermediate follow-up in several series.14, 21,22,27,29,31,36 Longer follow-up similar to the current series may reveal additional patients with long-term recurrences of significant gradients. The excellent success in our series of repeat BPV in relieving residual or recurrent obstruction is similar to the findings at other institutions.…”

“…Our patient population was similar to that of most other institutions that have reported acute and intermediate results, with comparable distributions regarding patient demographics and hemodynamic parameters before BPV. 8,913,14,[16][17][18][19][20][21][22][23][24][26][27][28][29]31,36,37 The proportion of patients with associated Noonan syndrome and/or pulmonary valve dysplasia was higher in the current series than that reported in the large multi-institutional case series of the Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry,13 for which uniform definitions of valve dysplasia were not specified.…”

Balloon dilation of critical valvar pulmonary stenosis in the first month of life

“…Overall, as noted in the Registry report, complications are more common in neonates than in older subjects, with mortality 3.5%, other major complications 3.5%, and those considered minor 15% [4]. There have been three procedure-related deaths to date [4, 9,12]. In this series one baby died of sepsis and necrotizing enterio- colitis and another developed endocarditis shortly after the procedure but recovered with treatment.…”