Mid-term results of balloon pulmonary valvuloplasty in children at queen alia heart institute

Abstract EN

Objective : To evaluate the mid-term results of balloon pulmonary valvuloplasty in children.

Methods : One hundred and thirty-two patients with a median age of three years (range 3 days to 16 years), underwent balloon pulmonary valvuloplasty between January 2000 and January 2007 at the Pediatric Cardiology Department of Queen Alia Heart Institute, Amman-Jordan.

We evaluated our patients with regard to clinical symptoms, peak to peak pressure gradient across the right ventricular outflow tract before and after balloon pulmonary valvuloplasty.

Thereafter, we followed them at our outpatient clinic regarding clinical symptoms, the peak instantaneous pressure gradient, the presence of pulmonary valve incompetence, right ventricular function based on echocardiographic findings, and the need for repeat balloon pulmonary valvuloplasty.

Results : There was significant reduction in the peak to peak gradient from 93.5 ± 32.3 mmHg to 26.1 ± 9.6 mmHg (P<0.001).

Repeat balloon pulmonary valvuloplasty was performed in 12% of cases.

Surgical intervention performed for dysplastic valve and fixed subpulmonic obstruction was done in 11.36% of cases.

Echo-Doppler data showed that residual peak instantaneous gradient dropped with time from 24.4±3 to 19 ± 6 mmHg (P<0.001) on follow up range (5 months to 5.2 years).

Mild to moderate pulmonary valve regurgitation was noticed in 34 patients (27.8%) at one year and in 43 patients (38%) at midterm follow up, but none had right ventricular dilatation or paradoxical interventricular septal motion.

Conclusions : The results of midterm follow up after balloon dilatation of the pulmonary valve is encouraging.

Restenosis occurred in 22% of cases.

Children under two years had statistically significant higher pressure gradient and more pulmonary regurgitation.

The degree of pulmonary regurgitation increased with time.

Longer term follow up studies should be undertaken to evaluate the significance of residual pulmonary regurgitation.