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Percutaneous Balloon Pulmonary Valvuloplasty of Critical Pulmonary Stenosis and Severe Pulmonary Stenosis in Neonates and Early Infancy: A Challenge in the Cyanotic Publisher



Mortezaeian H1 ; Khorgami M1 ; Omidi N2 ; Khalili Y1 ; Moradian M1 ; Zamani R1 ; Nazari E1
Authors
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Authors Affiliations
  1. 1. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  2. 2. Cardiac Primary Prevention Research Center, Tehran Heart Center and Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Cardiovascular and Thoracic Research Published:2021


Abstract

Introduction: Pulmonary stenosis with an intact ventricular septum (PS-IVS) is one of the common causes of cyanotic heart disease in neonates with diverse morphologies as well as management and treatment protocols. The aim of this study was to evaluate short and midterm results of balloon pulmonary valvuloplasty (BPV) for this disorder. Methods: Between 2012 and 2016, Totally 45 neonates and infants under 6 months old were evaluated. The patients had a minimum right-to-left ventricular pressure ratio of 1, right-to-left shunting at the patent foramen ovale or atrial septal defect level, and tricuspid valve Z-scores higher than -4. Results: Immediately after the procedure, the right ventricular pressure dropped to the normal values in 8 (20%) patients. The immediate procedural success rate was seen in 42 (93.3%) cases: the right-to-left ventricular pressure ratio dropped to below 50% or the level of O2 saturation rose above 75%. Of three cases unresponsive to BPV, two of them underwent patent ductus arteriosus (PDA) stenting and one procedural death occurred. At 6 months' follow-up, of 42 patients, this pressure was still within the normal range in 36 (80%) infants, while it had returned to high values in 9 (20%) patients and necessitated repeat valvuloplasty. After BPV, severe pulmonary valve regurgitation was observed in 14.2% patients; the condition was more common when high-profile noncompliant balloons were used. Conclusion: Balloon pulmonary valvuloplasty in infants with PS-IVS confers acceptable results insofar as it improves echocardiographic parameters and hemodynamic changes at short- and midterm follow-ups. Balloon selection with sizes more than 1.2 of the diameter of the pulmonary valve annulus and the use of noncompliant high-pressure balloons results in higher degrees of pulmonary regurgitation. © 2021 The Author(s).