Balloon valvuloplasty of the pulmonary valve in adults

pp 387-391

Abstract

Percutaneous balloon valvuloplasty has developed as an excelent treatment modality in children with congenital pulmonic stenosis. This method decrease pulmonic valve gradient and right ventricular pressure both immediately and during follow-up with few complications. Less is known about the results and long-term follow-up of this procedure in adults. We evaluated the immediate outcome, complications and course of valvuloplasty in our experience with adult patients. Percutaneous balloon valvuloplasty was performed in 20 consecutive patients (10 males) with a mean age of 31 years (range 18 to 70). All patients had clinical and echocardiographic diagnosis of significant congenital pulmonary valve stenosis. The diameter of the pulmonary valve annulus was estimated by cross-sectional echocardiography and cineangiography (20.5 ± 0.35 mm vs 20.5 ± 0.34 mm; p= NS). Percutaneous balloon valvuloplasty was performed by standard techniques using 1 (11 patients), 2 (8 patients) or 3 balloons (1 patient) over guide wires through a femoral vein approach. Percutaneous balloon valvuloplasty was technically successful in all 20 patients. Peak transpulmonic valve gradient decreased from88 ± 8 to 33 ±7 mmHg (p<0.001) and right ventricular systolic pressure decreased from 107 ± 9 to 55 ± 8 mmHg (p<0.001) immediately after the procedure. Peak transpulmonic gradient assessed by Doppler echocardiography was 78 ± 5 before the valvuloplasty, 29 ±4 immediately (p < 0.001) and 20±2 mmHg (p<0.05) at the follow-up in 16 patients who were controlled for periods between 6 and 30 months (mean 18 months). Eight patients persisted with an infundibular gradient that decreased during follow-up. One death occurred in our series (an elderly man with chronic pulmonary and coronary heart disease). Minor and transient com-plications like bradycardia, chest pain, ventricular arrhythmias or hypotension, also occurred. Percutaneous balloon valvuloplasty is a promising technique for the treatment of adult patients with congenital pulmonic stenosis. The immediate hemodynamic results appear similar to previous reports in infants and children and so do sustained improvement during follow-up. Major complications are rare. Percutaneous balloon dilation appears warranted as the primary treatment for adult patients with severe congenital pulmonary valve stenosis.