Percutaneous Balloon Valvuloplasty for Pulmonic Stenosis in Adolescents and Adults

Abstract

Patients with congenital pulmonic stenosis who present in late adolescence or adult life can be treated with percutaneous balloon valvuloplasty with excellent short-term and long-term results that are similar to those in young children.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…A nonsurgical approach with balloon valvotomy was described in 1982 840 and by the late 1980s had become the procedure of choice in the United States for the typically domed, thickened valve, both for children 841 and adults. 842,843 Surgery is still usually required for the dysplastic valve often seen in Noonan's syndrome. Although long-term follow-up of pulmonary balloon valvotomy is not yet available, the early and midterm results (up to 10 years) 844 suggest that the long-term results will be similar to surgical valvotomy, that is, little or no recurrence over a 22-to 30-year period.…”

Steps Toward Percutaneous Aortic Valve Replacement

“…[1][2][3] In particular, stenosis of mitral, 4 aortic, 5,6 or pulmonary valves 7,8 can be treated by percutaneous dilatation with good results. However, surgery remains the first-line treatment for valvular insufficiency despite recent advances in pulmonary valve replacement via the percutaneous technique.…”

Right-Sided Valve Disease Deserves a Little More Respect

“…42 PBV is the procedure of choice for children and adults with severe or symptomatic PS and carries a low risk of morbidity, mortality, and restenosis. 14,[43][44][45][46][47][48] However, a high frequency of PR has been reported; after PBV, 57% of children had moderate or severe PR at the last follow-up. 49 These data emphasize the need for lifelong follow-up after PBV.…”

“…47 Thus, best results are seen in patients with congenital stenosis with fused, but thin, leaflets and a normal annulus size. After PBV, the transpulmonic gradient usually decreases by two thirds of its baseline value.…”

“…After PBV, the transpulmonic gradient usually decreases by two thirds of its baseline value. 47,48 The procedure is not recommended in patients with acquired PS related to carcinoid or rheumatic disease because of the nature of valve involvement, commonly associated PR, and concomitant other valve involvement.…”