J Cardiovasc Ultrasound.  2013 Mar;21(1):18-22. 10.4250/jcu.2013.21.1.18.

The Comparison between the Echocardiographic Data to the Cardiac Catheterization Data on the Diagnosis, Treatment, and Follow-Up in Patients Diagnosed as Pulmonary Valve Stenosis

• Kim DH
• Park SJ
• Jung JW
• Kim NK
• Choi JY

• KMID: 1428372
• DOI: http://doi.org/10.4250/jcu.2013.21.1.18

Abstract

BACKGROUND
Isolated pulmonary valve stenosis (PS) makes up 6-9% of all congenital heart defects among children. The initial gold standard for diagnosis, follow-up of PS is by echocardiography. However, the most accurate diagnosis still remains to be measurement of the pressure gradient through transcatheterization. The purpose of this study is to compare the difference between the echocardiographic data to the cardiac catheterization data on the diagnosis, treatment, and follow-up in patients diagnosed as PS, and to see what parameters should be closely monitored.
METHODS
A total of 112 patients (Male : Female = 46 : 66) who underwent balloon pulmonary valvuloplasty (BPV) at Severance Cardiovascular Hospital, between December, 2002 to August, 2012 were retrospectively analyzed. The patients were all under 16 years of age and critical PS patients who underwent BPV were excluded from this study.
RESULTS
The pre-BPV right ventricle (RV)-pulmonary artery (PA) systolic pressure gradient and post-BPV systolic pressure gradient showed statistically significant decrease. The pre-BPV RV-PA systolic pressure gradient and 3 month post-BPV systolic pressure gradient showed statistically significant decrease. The consistency between the echocardiographic data and cardiac catheterization data shows statistically significant consistency. The mean pressure gradient and systolic pressure gradient on the echocardiography shows high consistency when comparing with the cardiac catheterization data.
CONCLUSION
Our study shows that BPV in PS is a safe and effective procedure in children and adolescent. The standard echocardiographic evaluation of PS, during diagnosis and follow-up, should include mean transpulmonic pressure gradient, as well as the peak systolic pressure gradient. The success of the procedure should be held off until at least 3 months, only if the patients do not show any symptoms.

Keyword

Pulmonary valve stenosis; Percutaneous balloon pulmonary valvuloplasty; Echocardiography; Systolic pressure gradient; Mean transpulmonic pressure gradient

MeSH Terms

Adolescent
Arteries
Blood Pressure
Cardiac Catheterization
Cardiac Catheters
Child
Echocardiography
Female
Follow-Up Studies
Heart Defects, Congenital
Heart Ventricles
Humans
Pulmonary Valve
Pulmonary Valve Stenosis
Retrospective Studies

Figure

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  Fig. 1 The echocardiographic RV-PA systolic pressure gradient during follow-up. Pre-BPV RV-PA systolic pressure gradient (pre), 1 day following (post) after BPV, 1 week follow-up (1 week), 3 month follow-up (3 month). Note significant reduction (p < 0.001) after BPV which remains unchanged [p > 0.1 (0.23)] at 1 week. However, at long term follow-up there was further fall (p < 0.001). RV: right ventricle, PA: pulmonary artery, BPV: balloon pulmonary valvuloplasty.

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