Significant pulmonary valve incompetence following oversize balloon pulmonary valveplasty in small infants: A long-term follow-up study

Abstract

Oversized dilatation balloons are recommended for relief of valvar pulmonic stenosis in infants and children during cardiac catheterization. Little information exists about the long‐term outcome of this practice. Six of 107 consecutive patients undergoing balloon pulmonary valveplasty developed increasing pulmonary valve incompetence during follow‐up periods of 0.5–10 years (mean, 7.2 years). Secondary right ventricular dilatation prompted insertion of a bioprosthetic pulmonary valve in one patient 6.8 years after intervention; valve replacement is pending in two additional patients, 4.3 and 10 years after intervention, respectively; and the three remaining subjects are thought likely to require valve replacement during childhood. The six reported subjects differ from the pulmonary valveplasty group as a whole in that they are younger (median age, 3 days vs. 11 months), had a higher degree of obstruction (right/left ventricular systolic pressure ratio prior to valveplasty 1.28 vs. 0.92), and underwent dilatation with relatively oversized balloons (balloon diameter to pulmonary valve annulus ratio 1.44 vs. 1.08). The balloon diameter to valve annulus ratio did not exceed 1.5 in any subject. Caution is advised in the use of oversized dilatation balloons in neonates or young infants with severe or critical pulmonic stenosis. Long‐term consequences of substantial pulmonary valve incompetence outweigh, in our opinion, the limited gradient relief achieved with smaller balloons, sometimes requiring a second dilatation of the valve at an older age and larger size. Cathet. Cardiovasc. Intervent. 48:61–65, 1999. © 1999 Wiley‐Liss, Inc.

Balloon Valvuloplasty for Pulmonary Stenosis in Children: Immediate Outcome and Cardiac Remodeling during Midterm Follow-up

“…Another important complication is tricuspid valve insufficiency (TI). Moderate TI was detected in 1% of our patients just like in other researches (14)(15)(16)(17)(18)(19)(20)(21)(22).…”

“…Several researches have reported a high prevalence of PI after BPV, but no one required surgical intervention for therapy (19,20) with the exception of Berman and colleagues, who reported that 6 of 107 BPVs needed pulmonary valve replacement due to right ventricular dilation (20). Careful selection of balloon size reduces the PI risk (21).…”

Balloon Valvuloplasty and Angioplasty in Pediatric Practice

“…Doppler echocardiographic evaluation at followup is reflective of the results without the necessity for repeat cardiac catheterization. Recent studies suggested pulmonary insufficiency as potential problem [7,10,11]. It appears that use of large non-compliant balloons may be associated with pulmonary insufficiency [11].…”

“…Recent studies suggested pulmonary insufficiency as potential problem [7,10,11]. It appears that use of large non-compliant balloons may be associated with pulmonary insufficiency [11]. Consequently the revised recommendations are to achieve balloon/ annulus ratios of 1.2 to 1.25 [12,13].…”

Restenosis after balloon valvuloplasty in a dog with pulmonary stenosis

“…A previous study demonstrated that BV improved clinical signs and survival time [1], and BV has been recognized as an effective and safe technique in humans and dogs when performed in indicated patients [3, 7, 19]. …”