Percutaneous Balloon Valvuloplasty for the Treatment of Isolated Pulmonary Valve Stenosis in Infants - A Single Centre Experience

INTRODUCTION: Pulmonary stenosis (PS) is a common congenital heart defect characterized by obstruction from the right ventricle to the pulmonary arteries. Few studies evaluate the long-term outcomes of the procedure, especially the degree of pulmonary regurgitation. We assessed the outcomes of infants following valvuloplasty for pulmonary valve stenosis.
METHODS: We conducted a retrospective analysis of children with pulmonary valve stenosis who underwent pulmonary balloon valvuloplasty (BPV) at a single institution. Clinical summaries, catheterization data, and echocardiographic data were reviewed. The inclusion criteria were isolated balloon pulmonary valvuloplasty for pulmonary valve stenosis, with age <2 months at the time of intervention.
RESULTS: Between 2006 and 2019, 104 patients underwent BPV for isolated PS. A total of 78 patients met the inclusion criteria. The median age at valvuloplasty was 6.5 days (1-60 days). The median last follow-up after valvuloplasty was 23.5±33.6 months. Pre-operative peak instantaneous pulmonary gradient (PIPG) measured by echocardiography was 70 (35-120) mmHg, which reduced to 26 (10-70) mmHg post-procedure. At the last follow-up, the gradient was 25 (0-100) mmHg. The mean balloon/annulus ratio was 1.18±0.12. Concerning the development of pulmonary regurgitation, mild pulmonary regurgitation was most observed [in 36 patients (46%)], and no patient developed severe regurgitation. Additionally, a correlation was found between female gender, preoperative gradient, pulmonary valve structure, and high residual gradient (p<0.0001, R>700).
DISCUSSION AND CONCLUSION: Pulmonary balloon valvuloplasty remains a safe and effective treatment for children with isolated pulmonary valve stenosis, with excellent long-term outcomes and no mortality. Although the rate of reintervention is high in cases with a low mean balloon/annulus diameter ratio, the rate of pulmonary regurgitation is significantly lower.