EVALUATION OF INITIAL AND MEDIUM-TERM RESULTS OF BALLOON PULMONARY VALVULOPLASTY IN CRITICAL VALVULAR PULMONARY STENOSIS IN NEONATES AND YOUNG INFANTS

Hani Mahmoud Adel*

ABSTRACT

Introduction: Critical pulmonary valve stenosis (PVS) is a life-threatening congenital heart defect. Balloon pulmonary valvuloplasty was first introduced as a therapeutic procedure by Kan et al in 1982. Over the years, management of critical PVS in young infants has evolved from surgical reconstruction of the right ventricular outflow tract and closed pulmonary valvotomy to transcatheter balloon pulmonary valvuloplasty (BPV), which is now the standard therapeutic procedure. Objectives: To evaluate the initial and medium-term results of BPV in neonates and young infants with critical PVS as carried out at the Alexandria University Children’s Hospital. Patients and Methods: From 2009 through 2017, 61 neonates and young infants with critical PVS were subjected to BPV. They were followed-up by clinical and echocardiographic evaluation for 1->7 years, after BVP. Results: The mean age of the patients was 48.9 ± 45.3 days and mean weight was 4.29 ± 1.33 kg. The mean PV annulus diameter by echo was 8.3± 1.2(6-11.5) mm, whereas by angiographic measurement was 7.9± 1.2 mm (5.4-11.5). The mean Doppler gradient across the PV was 128.1±15.8 mmHg and the mean catheter gradient was 96.7±11 mmHg. The mean inflated balloon diameter was 10.4±1.5 mm. The balloon/PV annulus ratio by angiogram was 1.32±0.06. The mean pressure gradient across PV post-ballooning was 21.7±9.7 mmHg by Doppler and 1.9 ± 6.4 mmHg by catheter. The SaO2 increased from 88.9±3.1% pre-ballooning to 94.3±1.9% post-ballooning. Complete success was achieved in 58 cases (95%). Complications were encountered in 5 cases (8.2%), all recovered completely. Residual gradient occurred in 3 cases (4.9%). Re-intervention was done in 5 cases (8.2%). Conclusions: BPV for critical PVS in neonates and young infants is feasible, effective and safe; and offers a great chance of saving such babies, but is technically demanding and could have some complications.

Keywords: Critical pulmonary stenosis-Balloon pulmonary valvuloplasty- Newborn-Infants.