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Balloon pulmonary valvuloplasty (BPV) is the treatment of choice for valvar pulmonary stenosis (PS) in children. Current practice favors surgical repair of moderate, severe, and symptomatic PS when a coexisting supravalvar component (SV) is present. This approach has been derived from the lack of immediate reduction in total pulmonary gradient (TPG) and right ventricular pressures from BPV, as well as adverse events related to the procedure. We evaluated the outcomes of children at a single institution who underwent BPV for PS and SV.
A retrospective analysis of outcomes in children with PS and SV following BPV was performed. Our cath database was searched for patients undergoing BPV for PS with both valvar and supravalvar components since 2004. Inclusion criteria: age < 19 years and no previous cardiac surgery.
Twenty three patients were identified. Median age at BPV was 0.5 years (IQR 0.3-2). Surgery was avoided in 15/23 (65%) [Group 1] and required in 8/23 (35%) [Group 2] following BPV. Reasons for surgery were: persistent symptoms in 5/8 (63%) and worsening TPG in 3/8 (37%). Median time to surgery following BPV in Group 2 was 0.9 years (IQR 0.2-1.9). Group 1 had a mean baseline peak echo TPG of 60 mmHg (± 12) that decreased to 44 mmHg (± 10) following BPV (p <0.01). TPG by echo decreased further to 21 mmHg (± 13) at 3.6 years (± 2.2) following BPV (p<0.01). Group 2 had a mean baseline peak echo TPG of 68 mmHg (± 17). TPG was unchanged by 1st echo after BPV at 56 mmHg (± 13) and just prior to surgery at 63 mmHg (± 15), (p > 0.10). Mean RV/LV pressure ratio was higher in Group 2 versus Group 1 at baseline (0.89 vs. 0.75, p <0.05) and post-BPV (0.9 vs. 0.64, p<0.05). No adverse events related to BPV were observed.
BPV has minimal acute effect on PS with a SV component, yet long term benefits are achieved in most patients. BPV should be considered first line therapy given its safety and long term effectiveness. Continued close medical follow-up is necessary following BPV. Only those with persistent symptoms, near systemic right ventricular pressures, or worsening TPG should be referred for surgical repair. A higher RV/LV pressure ratio at cath confers a higher risk for future surgical intervention.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Congenital Catheter Interventions
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1291-124
- 2013 American College of Cardiology Foundation