Percutaneous Balloon Valvuloplasty with Trefoil Balloon Catheter for the Treatment of Congenital Pulmonary Stenosis in Children

Hwang, Jin Soo; Ma, Jae Sook

Abstract

The efficacy of percutaneous balloon valvuloplasty in the treatment of congenital pulmonary valve stenosis is significantly improved with the use of large single balloon. But this technique may increase the hemodynamic compromise, that is, substantial drop of systemic pressure and significantly increased right ventricle pressure during maximal balloon inflation. The aim of this study was to assess efficacy and safety of percutaneous balloon valvuloplasty with Trefoil balloon catheter for the treatment of congenital pulmonary valve stenosis. This catheter, which consist of three identical angioplasty balloons, does not completely interrupt the blood flow during inflation. During the period of five years, between June 1990 and May 1995, percutaneous valvuloplasty with Trefoil balloon catheter was performed in 21 children with congenital pulmonary valve stenosis at Chonnam University Hospital. The effect and complications of pulmonary valve stenosis were investigated. The results were follows: 1) The transpulmonary pressure gradient was 65.8+/-38.4 mmHg before balloon pulmonary valvuloplasty, decreasing to 37.6+/-30.2 mmHg immediately after balloon pulmonary valvuloplasty (p<0.01). 2) The right ventricular peak systolic pressure decreased from 87.6+/-38.4 mmHg to 57.8+/-30.4 mmHg (p< 0.01). 3) Follow-up CW Doppler data revealed, this decreased pressure gradient have maintained of further decreased in 13 follow-up children, except one case with TOF. 4) No children developed symptoms of significant hypertension or bradycaria as a result of the procedure but one patient who was complicated with fracture of guide-wire. In conclusion, percutaneous balloon valvuloplasty with Trefoil balloon catheter is the effective and safe method in treatment of congenital pulmonary stenosis without significant complications