Abstract

CADAVID, Ana M et al. Percutaneous pulmonary valvuloplasty with balloon. Results and short and medium term follow up. Rev. Colomb. Cardiol. [online]. 2006, vol.12, n.7, pp.484-491. ISSN 0120-5633.

Objective: to assess the results and 10 years follow-up of percutaneous pulmonary valvuloplasty in an institution. Methods: retrospective, descriptive study of 187 patients with pulmonary stenosis to whom a valvuloplasty with balloon was performed between 1995 and 2005. The procedure was classified as successful when the transvalvular pulmonary gradient diminished to <30 mm Hg during the procedure. The restenosis is defined as gradients e >30 mm Hg, by echocardiography, after an effective procedure. Results: 192 valvuloplasties were performed in 187 patients, 51.9% male, mean age between 3.1 ± 3.8 years (between 1 day and 21 years) and mean weight 13.18 ± 11.14 kg (2.5 to 55 Kg). 11.7% of the patients were newborns, 22.5% were critical stenosis and 27.8% were associated to congenital cardiopathy. 95.2% of valvuloplasties were successful with significant reduction of the transvalvular gradient from 63.32 ± 28.05 mm Hg to 9.57 ±10.41 mm Hg (p=0.000) and from the right ventricular systolic pressure from 84.09 ± 28.91 mm Hg to 39.89 ±16.98 mm Hg (p=0.000). It was found a relation between the presence of an associated cardiopathy and the need of a second valvuloplasty (p=0.000), as well as between the performance of surgery (p=0.000) and the presence of restenosis (p=0.000). There were complications in 17 patients, being the embolic phenomena the most frequent ones. Only a newborn with critical stenosis and cardiogenic shock previous to the procedure, died. Follow-up of 129 patients (68.7%) between 1 month and 9.5 years (mean age 1.73 ± 2.41 years) was realized. Significant restenosis was presented in 24 (18.6%) patients, moderate in 13 and severe in 11. Restenosis was related to a lesser diameter in the pulmonary ring (p=0.006) and with valvular dysplasia (p=0.011). No significant relationship between restenosis and patient’s age in the first valvuloplasty (p=0.607), the use of a balloon (p=0.053), the relationship balloon / ring (p=0.108) or the gradient post valvuloplasty (p=0.559) was found. There was a clear relationship between the presence of isolated valvular stenosis and a lesser frequency of restenosis (p=0.000). Five patients (2.6%) required a second valvuloplasty. No relationship was found between valvular dysplasia, the initial transvalvular gradient, the residual gradient, the balloon/ring relation or the antecedent of previous surgery or valvuloplasty, with the need of a second valvuloplasty. Ten patients underwent surgery, all of them with an associated cardiopathy. In 97 (51.8%) patients, pulmonary insufficiency was found. In 96.9% it was trivial or minor, in 2.1% moderate and only in 1% it was severe. 60% of the patients, who were followed up, remain free from events (restenosis) after five years. In patients with stenosis alone, this percentage is 80% with a statistical significant difference respect to those with an associated cardiopathy (p=0.000) The events-free survival when comparing critical patients with the non-critical ones, does not show a significant difference (p=0.850) and there was neither a difference for the newborns (p=0.752).

Keywords : pulmonary valvular stenosis; percutaneous pulmonary valvuloplasty; pulmonary restenosis.

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