Percutaneous balloon valvotomy of congenital pulmonary stenosis using oversized balloons

Abstract

Percutaneous balloon valvotomy was attempted in 27 patients (aged 6 days to 19 years, median 2 years, 11 months) with unoperated typical valvular pulmonary stenosis using a balloon 7 to 60% (mean 30%) larger than the valve anulus. One patient had undergone a previous balloon valvotomy elsewhere. To achieve an oversized dilation diameter in three larger patients, two balloons were inflated side by side. Their "effective dilation diameter" was determined by the diameter of the circle with the same area as that of the oval enveloping the two balloons. A significant reduction of the transvalvular gradient occurred in all patients (mean +/- SD = 74.3 +/- 14.7%, range 33 to 100%). The average gradient of 65.0 +/- 19.0 mm Hg (mean +/- SD) fell to 15.9 +/- 7.6 mm Hg (0 to 30 mm Hg). Twenty-five of 27 patients had a residual transvalvular gradient of less than 25 mm Hg. The calculated valve orifice area increased by an average of 183 +/- 80%. No significant complications occurred. It is concluded that percutaneous balloon valvotomy with a balloon 20 to 40% larger than the valve anulus is the treatment of choice for typical congenital valvular pulmonary stenosis.

Balloon mitral valvotomy by using the twin‐at catheter: Immediate results and complications in 110 patients

“…This difference was explained by a 45% greater balloon diameter to the mitral valve annulus ratio given by the double balloon technique compared to the Inoue catheter. When the effective dilatation diameter of a double balloon technique is computed [22], two 20 mm diameter balloons are equivalent to a 32.7 mm diameter single balloon and a 20 + 18 mm combination equals a 3 1.1 mm diameter single balloon. Therefore using the Inoue system in large Caucasian patients may necessitate an overdistension of the balloon, larger than 30 mm, but the use of overlarge Inoue balloons have been shown clearly to increase the severity of mitral regurgitation [23].…”

Pulmonary stenosis

“…Special points It should be noted that infundibular obstruction sometimes accompanies valvar obstruction but frequently resolves after relief of the valvar lesion [8,15]. Although the recommendation to use a balloon annulus ratio of 1.2:1 to 1.4:1 is made based on reliable data [16][17][18], a recent report [19] suggests that larger balloons (particularly if they are used in neonates) are likely to produce more severe pulmonary insufficiency. Therefore, the current thinking is to limit the balloon/annulus ratio to 1.2:1 [20].…”

Interventional Pediatric Cardiology: State of the Art and Future Directions

“…The indications for balloon therapy should be the same as those used for surgical valvotomy: a moderate degree of pulmonary valve stenosis with a peak-to-peak or peak instantaneous gradient ജ50 mmHg with normal cardiac index [104]. The size of the balloon used for valvuloplasty should be 1.2 to 1.4 times that of pulmonary valve annulus [97,99,100,103,132]. Excellent relief of pulmonary valve obstruction by balloon valvuloplasty has been well documented in neonates, infants, children and adults.…”