Yonsei Med J.  2008 Jun;49(3):416-421. 10.3349/ymj.2008.49.3.416.

Major Determinants and Long-Term Outcomes of Successful Balloon Dilatation for the Pediatric Patients with Isolated Native Valvular Pulmonary Stenosis: A 10-Year Institutional Experience

• Lee ML
• Peng JW
• Tu GJ
• Chen SY
• Lee JY
• Chang SL

• KMID: 724257
• DOI: http://doi.org/10.3349/ymj.2008.49.3.416

Abstract

PURPOSE
We report herein major determinants and long- term outcomes of balloon dilatation (BD) for 27 pediatric patients with isolated native valvular pulmonary stenosis (VPS). MATERIALS AND METHODS: From May 1997 to May 2003, 27 pediatric patients with VPS (pressure gradients> or =40mmHg) were enrolled in this retrospective study. Single-balloon maneuver was applied in 26 patients, and double- balloon maneuver in 1. After BD, the pressure gradients were documented simultaneously by pullback maneuver by cardiac catheterization and echocardiography within 24 hours, at 1- month, 3-month, 1-year, and 4-to-10-year follow-ups. RESULTS: Before BD, the echocardiographic gradients ranged from 40 to 101mmHg (61+/-19, 55), and from 40 to 144mmHg (69+/-32, 60) by pressure recordings. After BD, the gradients ranged from 12 to 70mmHg (29+/-13, 27) by pressure recording (p<0.001), and from 11 to 64mmHg (27+/-12, 26) by echocardiography within 24 hrs (p<0.001). The ratios of the systolic pressure of the right ventricle to those of the left ventricle were 55 to 157% (89+/-28, 79%) before BD, and 30 to 79% (47+/-13, 42%) after BD p<0.001). Follow-up (7.7+/-5.7, 4.5 years) echocardiographic gradients ranged from 11 to 61mmHg (25+/-11, 24). Two patients did not have immediate success owing to infundibular spasm. Improved right ventricular compliance could be accounted for the ultimate success in these 2 patients. The ultimate successful rate was 100%. CONCLUSION: BD can achieve excellent long-term outcomes in the pediatric patients with isolated native VPS.

Keyword

Balloon dilatation; pediatric; valvular pulmonary stenosis

MeSH Terms

Adolescent
Balloon Dilatation/adverse effects/*methods
Child
Child, Preschool
Echocardiography
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Pulmonary Valve Stenosis/pathology/physiopathology/*therapy
Retrospective Studies
Time Factors
Treatment Outcome

Reference

1. Kan JS, White RI Jr, Mitchell SE, Gardner TJ. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary valve stenosis. N Engl J Med. 1982. 307:540–542.

2. Gournay V, Piéchaud JF, Delogu A, Sidi D, Kachaner J. Balloon valvotomy for critical stenosis or atresia of pulmonary valve in newborns. J Am Coll Cardiol. 1995. 26:1725–1731.

3. Cheatham JP. Garson A, Bricker JT, McNamara DG, editors. Pulmonary stenosis. The science and practice of pediatric cardiology. 1990. Philadelphia: Lea & Febiger;1382–1420.

4. Radtke W, Keane JF, Fellows KE, Lang P, Lock JE. Percutaneous balloon valvotomy of congenital pulmonary stenosis using oversized balloons. J Am Coll Cardiol. 1986. 8:909–915.

5. Zeevi B, Keane JF, Fellows KE, Lock JE. Balloon dilation of critical pulmonary stenosis in the first week of life. J Am Coll Cardiol. 1988. 11:821–824.

6. Wang JK, Wu MH, Lee WL, Cheng CF, Lue HC. Balloon dilatation for critical pulmonary stenosis. Int J Cardiol. 1999. 69:27–32.

7. Latson L, Cheatham J, Froemming S, Kugler J. Transductal guidewire "rail" for balloon valvuloplasty in neonates with isolated critical pulmonary valve stenosis or atresia. Am J Cardiol. 1994. 73:713–714.

8. Lee ML, Chiu IS. Inhaled nitric oxide for persistent pulmonary hypertension in a neonate with pulmonary atresia and intact ventricular septum after radiofrequency valvulotomy, balloon valvuloplasty and Blalock-Taussig shunt. Int J Cardiol. 2003. 87:273–277.

9. Coe JY, Chen RP, Dyck J, Byrne P. Transaortic balloon valvoplasty of the pulmonary valve. Am J Cardiol. 1996. 78:124–126.

10. Fedderly RT, Lloyd TR, Mendelsohn AM, Beekman RH. Determinants of successful balloon valvotomy in infants with critical pulmonary stenosis or membranous pulmonary atresia with intact ventricular septum. J Am Coll Cardiol. 1995. 25:460–465.

11. Talsma M, Witsenburg M, Rohmer J, Hess J. Determinants for outcome of balloon valvuloplasty for severe pulmonary stenosis in neonates and infants up to six months of age. Am J Cardiol. 1993. 71:1246–1248.

12. Gildein HP, Kleinert S, Goh TH, Wilkinson JL. Treatment of critical pulmonary valve stenosis by balloon dilatation in the neonate. Am Heart J. 1996. 131:1007–1011.

13. Ladusans EJ, Qureshi SA, Parsons JM, Arab S, Baker EJ, Tynan M. Balloon dilatation of critical stenosis of the pulmonary valve in neonates. Br Heart J. 1990. 63:362–367.

14. Burzynski JB, Kveselis DA, Byrum CJ, Kavey RW, Smith FC, Gaum WE. Modified technique for balloon valvuloplasty of critical pulmonary stenosis in the newborn. J Am Coll Cardiol. 1993. 22:1944–1947.

15. Ali Khan MA, al-Yousef S, Huhta JC, Bricker JT, Mullins CE, Sawyer W. Critical pulmonary valve stenosis in patients less than 1 year of age: treatment with percutaneous gradational balloon pulmonary valvuloplasty. Am Heart J. 1989. 117:1008–1014.

16. Qureshi SA, Ladusans EJ, Martin RP. Dilatation with progressively larger balloons for severe stenosis of the pulmonary valve presenting in the late neonatal period and early infancy. Br Heart J. 1989. 62:311–314.

17. Moulaert AJ, Buis-Liem TN, Geldof WC, Rohmer J. The postvalvulotomy propranolol test to determine reversibility of the residual gradient in pulmonary stenosis. J Thorac Cardiovasc Surg. 1976. 71:865–868.

18. Johnson LW, Grossman W, Dalen JE, Dexter L. Pulmonic stenosis in the adult. Long-term follow-up results. N Engl J Med. 1972. 287:1159–1163.

19. Caspi J, Coles JG, Benson LN, Freedom RM, Burrows PE, Smallhorn JF, et al. Management of neonatal critical pulmonic stenosis in the balloon valvotomy era. Ann Thorac Surg. 1990. 49:273–278.

20. Hanley FL, Sade RM, Freedom RM, Blackstone EH, Kirklin JW. Outcomes in critically ill neonates with pulmonary stenosis and intact ventricular septum: a multiinstitutional study. Congenital Heart Surgeons Society. J Am Coll Cardiol. 1993. 22:183–192.

21. Colli AM, Perry SB, Lock SE, Keane SF. Balloon dilation of critical valvar pulmonary stenosis in the first month of life. Cathet Cardiovasc Diagn. 1995. 34:23–28.

22. Tabatabaei H, Boutin C, Nykanen DG, Freedom RM, Benson LN. Morphologic and hemodynamic consequences after percutaneous balloon valvotomy for neonatal pulmonary stenosis: medium-term follow-up. J Am Coll Cardiol. 1996. 27:473–478.