Balloon Dilatation for Critical Pulmonary Stenosis

Abstract

This study was conducted to investigate the outcome of balloon valvuloplasty for critical pulmonary stenosis in young infants. During a 6 .2-year period between January 1992 and February 1998, 34 infants with critical pulmonary stenosis, aged 1 to 58 days (16.8±16.6 days), underwent attempted balloon valvuloplasty in this institution. The procedure was accomplished in 28 patients, but failed in six . Surgical pulmonary valvotomy was performed in the six patients with one mortality. Immediately following valvuloplasty, the mean right ventricular systolic pressure decreased from 109.2±28.6 to 55.1±23.6 mmHg in the 28 patients (P<0.01). The mean pressure gradient decreased from 85.6±29.4 to 26±21.4 mmHg (P<0.01). However, one who had a severely hypoplastic right ventricle requiring prolonged prostaglandin E1 infusion after valvuloplasty underwent a right ventricular outflow tract patch. After a follow-up period ranging from 2 months to 6.4 years (30.5±19.1 months ), one patient developed recurrent pulmonary stenosis and underwent a repeated balloon valvuloplasty. Of the 27 patients (79%) with a definitive success of balloon valvuloplasty, the mean pressure gradient estimated with Doppler echocardiography at most recent follow-up was 15.2±6.8 mmHg. Therefore, balloon valvuloplasty is the procedure- of-choice for critical pulmonary stenosis. Surgery should be reserved for those with unsuccessful balloon valvuloplasty.