scholarly journals Results of Balloon Valvuloplasty in Typical and Dysplastic Pulmonary Valve Stenosis: Doppler Echocardiographic Follow-Up

1988 ◽  
Vol 4 (6) ◽  
pp. 332-332
Keyword(s):  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Dysplastic Pulmonary Valve

scholarly journals Results of balloon valvuloplasty in typical and dysplastic pulmonary valve stenosis: Doppler echocardiographic follow-up

1988 ◽  
Vol 12 (2) ◽  
pp. 476-479 ◽  
Author(s):  
Pablo M. Marantz ◽  
James C. Huhta ◽  
Charles E. Mullins ◽  
Daniel J. Murphy ◽  
Michael R. Nihill ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Dysplastic Pulmonary Valve

Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

2021 ◽  
Author(s):  
Sonia B. Albanese Albanese
Keyword(s):  
Surgical Treatment ◽  
Pressure Gradient ◽  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Group I ◽  
Mean Pressure ◽  
Valve Function ◽  
Group Ii

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

Long-term results of percutaneous balloon valvuloplasty in neonatal critical pulmonary valve stenosis: a 20-year, single-centre experience

2017 ◽  
Vol 27 (7) ◽  
pp. 1314-1322
Author(s):  
Petra Loureiro ◽  
Barbara Cardoso ◽  
Inês B. Gomes ◽  
José F. Martins ◽  
Fátima F. Pinto
Keyword(s):  
Pulmonary Valve ◽  
Pressure Ratio ◽  
Balloon Valvuloplasty ◽  
Long Term Results ◽  
Pulmonary Valve Stenosis ◽  
Single Centre ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Valvuloplasty

AbstractIntroductionPercutaneous balloon valvuloplasty is the primary treatment for critical pulmonary valve stenosis in neonates. Thus far, a few studies have reported long-term results of this technique in neonatal critical pulmonary valve stenosis.MethodsWe carried out a retrospective study of all consecutive newborns with critical pulmonary valve stenosis subjected to percutaneous balloon valvuloplasty at a single centre, between 1994 and 2014, to assess its immediate and long-term safety and efficacy.ResultsA total of 24 neonates presented with critical pulmonary valve stenosis. The mean diameter of the pulmonary annulus was 7 mm (±1.19); 33.3% had a dysplastic pulmonary valve, and 92% were started on prostaglandin E1 treatment. Percutaneous balloon valvuloplasty was performed at a mean age of 4.0±4.3 days using, on average, a balloon-to-pulmonary annulus ratio of 1.18 mm (with a range from 0.9 to 1.43). Immediate success was achieved in 22/24 patients (92%) with a reduction in the pulmonary transvalvular peak gradient (p<0.05) and in the right ventricle/systemic pressure ratio (p<0.05). There was one death (4%) 6 days after the procedure, and 29.2% of them had transient rhythm complications. For a mean follow-up time of 8.4 years, the re-intervention rate was 42.9%. In total, 14 re-interventions were performed in nine neonates, including surgery in six. Freedom from re-intervention was 50% at 8 years and 43% at 10 and 15 years.ConclusionThis series, to the best of our knowledge, has had the longest follow-up of neonates with critical pulmonary valve stenosis. Percutaneous balloon valvuloplasty is a safe and effective treatment, and in our study 75% of the patients were exclusively treated using this technique.

Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvuloplasty of critical pulmonary valve stenosis

2015 ◽  
Vol 26 (3) ◽  
pp. 556-568 ◽  
Author(s):  
Ikram Massoud ◽  
Nader Botros ◽  
Atef Yehia ◽  
Hassan Abdelghafoor ◽  
Mohamed Donya ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Right Ventricular ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Gadolinium Enhancement ◽  
The Right

AbstractBackgroundLittle data are published about right ventricular diastolic performance in patients with critical pulmonary valve stenosis after balloon pulmonary valvuloplasty thus far.MethodsA total of 44 patients with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with haemodynamic recordings were enrolled to the study; 33 patients who came for follow-up underwent further imaging by echocardiography after 6 months and their right ventricular functional parameters were compared with 33 control patients of the same age and sex. Out of 33 patients, 21 underwent cardiac MRI with late gadolinium enhancement to assess the presence of right ventricular fibrosis.ResultsThe right ventricular systolic pressure (p<0.0001) and right ventricular outflow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. During follow-up, M-mode left ventricular end diastolic dimension (p<0.001) and end systolic dimension increased (p<0.001), whereas right ventricular end diastolic dimension decreased (p<0.001). Compared with controls, patients (n=33) had significantly reduced tricuspid annular Ea and higher E/Ea (p<0.001). Right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (p<0.001). Late gadolinium enhancement was demonstrated in 13 out of 21 patients with restrictive physiology, which involves the anterior right ventricular outflow tract, anterior wall, and inferior wall. The right ventricular late gadolinium enhancement score correlated positively with age (r=0.7, p<0.001) and right ventricular mass index (r=0.52, p<0.001).ConclusionThe persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor – other than increase in afterload – is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.

Results of pulmonary balloon valvuloplasty persist and improve at late follow-up in isolated pulmonary valve stenosis

2017 ◽  
Vol 27 (8) ◽  
pp. 1566-1570 ◽  
Author(s):  
John J. Parent ◽  
Michael M. Ross ◽  
Edgard A. Bendaly ◽  
John P. Breinholt
Keyword(s):  
Effective Treatment ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Inclusion Criteria ◽  
Long Term Outcomes

AbstractBackgroundPulmonary balloon valvuloplasty is a safe and effective treatment for children with pulmonary valve stenosis. A few studies evaluate the long-term outcomes of the procedure, particularly the degree of pulmonary regurgitation. We evaluated the outcomes of children >1 year following valvuloplasty for pulmonary valve stenosis.MethodsA retrospective analysis of children with pulmonary valve stenosis following pulmonary balloon valvuloplasty at a single institution was performed. Clinic summaries, catheterisation data, and echocardiographic data were reviewed. Inclusion criteria were isolated pulmonary valve stenosis, age <19 years at the time of intervention, and at least one echocardiogram performed at least 1 year after valvuloplasty.ResultsA total of 53 patients met inclusion criteria. The median age at valvuloplasty was 0.4 years (0.01–10.6 years). The last follow-up was 4.8±2.3 years following valvuloplasty. The pre-valvuloplasty peak instantaneous gradient by echocardiography was 60.6±14.6 mmHg. The peak gradient at the first postoperative echocardiography was reduced to 25.5±12 mmHg (p<0.001), and further decreased to 14.8±15.8 mmHg (p<0.001) at the most recent follow-up. The degree of regurgitation increased from before valvuloplasty to after valvuloplasty (p<0.001) but did not progress at the most recent follow-up (p=0.17). Only three patients (5.7%) required re-intervention for increasing pulmonary stenosis (two surgical; one repeat balloon). No significant procedural complications occurred.ConclusionsPulmonary balloon valvuloplasty remains a safe and effective treatment for children with isolated pulmonary valve stenosis, with excellent long-term outcomes and no mortality. A few patients require further intervention. Long-term follow-up demonstrates decreased, residual stenosis. Patients have a small, acute increase in pulmonary regurgitation following valvuloplasty, but no long-term progression.

scholarly journals Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

2021 ◽  
Author(s):  
Sonia B. Albanese ◽  
Matteo Trezzi ◽  
Elena Pelliccione ◽  
Francesca Gatta ◽  
Alessia Del Pasqua ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pressure Gradient ◽  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Mean Pressure ◽  
Pulmonary Valve Insufficiency ◽  
Valve Insufficiency ◽  
Group 1

Abstract Background. Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on mid-term results.Methods. 123 consecutive patients were treated in our center between 07/1983 and 03/2019. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7 kg, respectively. Patients were categorized into 2 groups based on the onset of sparing valve techniques (1995). Short- and long-term mortality, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease and pulmonary valve insufficiency were analyzed.Results. Early mortality occurred exclusively before 1995 (Group 1, 3.76%, p=ns). Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9 mmHg to 16.46 ± 7.9 mmHg), but right outflow tract reintervention rate was greater in Group 1 (14.10% vs 2.3%, p = 0.04). At a mean follow-up interval of 4.9 ± 33 years, pulmonary valve insufficiency was severe in 2.47% of patients in Group 1, whereas it was mild to moderate in 33.3% of patients in Group 2, the latter having undergone unsuccessful percutaneous balloon valvuloplasty prior to surgery in the vast majority of cases (14/20 vs 6/22, p=0.023).Conclusions. Current pulmonary valve sparing techniques are associated with better results, both in terms of survival and freedom from re-intervention at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

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