scholarly journals Efficacy and safety of balloon valvuloplasty as a treatment of choice for pulmonary stenosis in children and adolescents

2014 ◽  
Vol 142 (9-10) ◽  
pp. 542-546
Author(s):  
Vojislav Parezanovic ◽  
Milan Djukic ◽  
Sanja Dzelebdzic ◽  
Tamara Ilisic ◽  
Igor Stefanovic ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Pulmonary Stenosis ◽  
Age Groups ◽  
Balloon Valvuloplasty ◽  
Pulmonary Artery Stenosis ◽  
Pulmonary Valve Insufficiency ◽  
Valve Insufficiency

Introduction. Pulmonary artery stenosis (PS) is a congenital heart defect which occurs in 10% of all congenital heart defects. Pulmonary balloon valvuloplasty (BVP) has been the treatment of choice of PS over the last 30 years. Objective. The purpose of this study was to evaluate the efficacy of this method based on middle-term hospital follow-up, and safety of BVP based on our experience. Methods. The study included 88 patients diagnosed with PS. The patients were divided into three groups based on the severity of the disease. Also, they were divided into two age groups in order to analyze the frequency of complications. Hemodynamic measurements and echocardiography results were recorded before, 24-36 hours after BVP and at the end of follow-up. Results. The studied group involved patients of average age 3.75?4.3 years (20 days to 17 years). Immediately after BVP a significant decrease of pressure gradient across the pulmonary valve (PV) was recorded in all patients; this result was similar in all 3 groups of patients regardless of the severity of stenosis (p<0.001). Complications of BVP occurred most commonly in children up to 12 months of age (ventricular tachycardia 4.5% and supraventricular tachycardia 6.8%). Pulmonary valve insufficiency after dilatation occurred in 6.6% of cases, and was most common in children aged up to 12 months. In 87 (98.9%) patients BVP was a definitive solution, and a significant residual stenosis was not recorded during follow-up. Conclusion. BVP is a safe and effective procedure in the treatment of isolated PS in children, regardless of the severity of stenosis but also regardless of patients? age.

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.

scholarly journals Natural Course of Isolated Pulmonary Valve Stenosis in Pediatric Patients

2020 ◽  
Vol 3 (2) ◽  
pp. 01-07
Author(s):  
Güven Serçin ◽  
Öztarhan Kazım
Keyword(s):  
Pediatric Patients ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Age Groups ◽  
Natural Course ◽  
Pulmonary Valve Stenosis ◽  
Valvular Stenosis ◽  
Patient Groups ◽  
The Impact

Aim: The aim of our study is to be able to predict the prognosis of patients with isolated pulmonary valvular stenosis on the basis of age and degree of stenosis. Identification of the course of pulmonary stenosis of different age groups will significantly contribute both to the physicians and the relatives of the patient. Material and Methods: 105 pediatric patients diagnosed with isolated pulmonary valvular stenosis were included in our study. We investigated the impact of the gradient of stenosis and the age at the time of diagnosis on the natural course of pulmonary stenosis. Mean follow-up time of the children was 19 months, 25.45±22.48 months. The patients were divided into four groups over their trans-valvular gradient degrees and<20 mmHg was defined as transient, 20-39 mmHg mild, 40-59 mmHg moderate, 60 mmHg and over as severe pulmonary stenosis. Results: Between two to five months, none of the moderate stenosis cases progressed unlike other patient groups. The decline in the final gradient versus initial gradient was significant in children between two to five months and six months to two years in our study, and yet there was no significant change of initial and final gradients in patients under one month, and at two years and over. Conclusion: It would be reasonable to conclude that the progression of pulmonary valvular stenosis is benign in patients with pulmonary valvular stenosis under 40 mmHg of systolic gradient diagnosed after 6th month of life.

Comparison of Right Ventricular Stroke Work for Tetralogy Patient and Normal Subject

2008 ◽  
Author(s):  
Ashish Das ◽  
William Gottliebson ◽  
Rupak K. Banerjee
Keyword(s):  
Right Ventricular ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Pulmonary Stenosis ◽  
The United States ◽  
Stroke Work ◽  
Loading Conditions ◽  
Clinical Issue

Tetralogy of Fallot (TOF), also called blue-baby syndrome is one of the most common congenital heart defects in children after infancy and is estimated to account for 10% of all congenital heart defects [3]. TOF consists of four interrelated lesions: i) ventricular septal defect ii) Pulmonary stenosis iii) Right ventricular (RV) hypertrophy and (iv) Overriding Aorta [3]. TOF has been successfully repaired for several decades (Fig. 1). There are now an estimated 100,000 adult “repaired TOF” patients in the United States alone. As a result, long-term sequelae of the disease and repair have become important clinical issue. Specifically, residual pulmonary valve insufficiency (PI) is one such accepted and often unavoidable sequela. PI, when severe, abnormally alters the RV loading conditions, thereby triggering RV hypertrophy and dilatation. In turn, RV dilatation can evolve into irreversible RV myocardial contractile dysfunction, and has been related to sudden death in many “repaired TOF” patients. To normalize RV loading conditions, pulmonary valve replacement is often necessary and should be performed prior to the onset of irreversible RV myocardial damage.

scholarly journals Rehabilitation of a Female Patient after Corrective Surgery for Tetralogy of Fallot

2015 ◽  
Vol 32 (4) ◽  
pp. 293-299
Author(s):  
Jovana Cvetković ◽  
Dragan Đ Đorđević ◽  
Milan Šljivić ◽  
Marina Deljanin Ilić
Keyword(s):  
Tetralogy Of Fallot ◽  
Female Patient ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Physical Exertion ◽  
Young Female ◽  
Palliative Surgery ◽  
Cardiovascular Rehabilitation ◽  
Pulmonary Valve Insufficiency ◽  
Valve Insufficiency

Summary Herein we present a 25-year-old female patient with tetralogy of Fallot (TOF). This congenital heart defect is not very common, but it is the most common one among cyanotic heart defects. Treatment of the patients with TF is surgical, with palliative or curative (corrective) intent. Our patient underwent palliative surgery, definitive correction, and another surgery for pulmonary valve insufficiency. During cardiovascular rehabilitation, the patient was rhythmically stable, with excellent tolerance of physical exertion. Bearing in mind that this was a young female person who previously had had two spontaneous abortions, pregnancy was not absolutely contraindicated, although spontaneous abortion and pregnancy complications were more common in these patients.

scholarly journals Genetic testing for pulmonary stenosis

2018 ◽  
Vol 2 (s1) ◽  
pp. 58-60
Author(s):  
Yeltay Rakhmanov ◽  
Paolo Enrico Maltese ◽  
Carla Marinelli ◽  
Tommaso Beccari ◽  
Munis Dundar ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Autosomal Recessive ◽  
Autosomal Dominant ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Pulmonary Stenosis ◽  
Autosomal Recessive Inheritance ◽  
Live Births ◽  
Gene Test ◽  
Pulmonary Arterial

Abstract Pulmonary stenosis (PS) is a congenital pulmonary valve malformation. It can be classified as valvular, subvalvular or supravalvular. Isolated forms of PS are rare. PS is associated with the development of massive pulmonary arterial dilatation. Patients with PS have a high consanguinity rate and the disorder is highly familial, which is why knowing the genetic aetiology of this defect is important. Prevalence is estimated at about 4/10,000 live births, and incidence at about 10% of all children with congenital heart defects. PS has prevalently autosomal dominant and rarely autosomal recessive inheritance. This Utility Gene Test was developed on the basis of an analysis of the literature and existing diagnostic protocols. It is useful for confirming diagnosis, as well as for differential diagnosis, couple risk assessment and access to clinical trials.

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 Rare combination of aortopulmonary septal defect with other heart defects

2001 ◽  
Vol 82 (6) ◽  
pp. 457-458
Author(s):  
V. A. Lukanikhin ◽  
G. I. Kharitonov ◽  
N. G. Shigabutdinova ◽  
B. A. Ostroumov
Keyword(s):  
Pulmonary Artery ◽  
Congenital Heart ◽  
Septal Defect ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Ascending Aorta ◽  
Pulmonary Artery Stenosis ◽  
Patent Ductus

Defects between the ascending aorta and the pulmonary artery are among the rare congenital heart defects (CHD), occurring at a rate of 0.27%. In 10-15% of cases this CHD is combined with patent ductus arteriosus (PDP), coarctation of the aorta. Single cases of its combination with pulmonary artery stenosis have been described in the literature. We present a case of successful correction of aortopulmonary septal defect (ASD) combined with PDP and stenosis of the bicuspid pulmonary valve.

scholarly journals Relief of branch pulmonary artery stenosis reduces pulmonary valve insufficiency in a swine model

2009 ◽  
Vol 138 (2) ◽  
pp. 382-389 ◽  
Author(s):  
Christopher J. Petit ◽  
Matthew J. Gillespie ◽  
Matthew A. Harris ◽  
Travis L. Seymour ◽  
Timothy Y. Liu ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Valve ◽  
Artery Stenosis ◽  
Pulmonary Artery Stenosis ◽  
Swine Model ◽  
Branch Pulmonary Artery ◽  
Branch Pulmonary Artery Stenosis ◽  
Pulmonary Valve Insufficiency ◽  
Valve Insufficiency

An unusual case of tetralogy of Fallot with an absent pulmonary valve associated with a retro-aortic innominate vein in a patient with a 16p12.2 microdeletion

2021 ◽  
pp. 1-2
Author(s):  
Niall Linnane ◽  
Andrew Green ◽  
Colin J. McMahon
Keyword(s):  
Aortic Arch ◽  
Tetralogy Of Fallot ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Unusual Case ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Innominate Vein ◽  
Absent Pulmonary Valve ◽  
Rare Association

Abstract 16p12.2 microdeletion has been associated with congenital heart defects and developmental delay. In this case, we describe the rare association between tetralogy of Fallot with an absent pulmonary valve a right-sided aortic arch and a retro-aortic innominate vein associated with a 16p12.2 microdeletion and epilepsy.

scholarly journals Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

2020 ◽  
Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

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