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Results of balloon dilatation of stenotic homografts in pulmonary position in children and young adults

Published online by Cambridge University Press:  07 March 2012

Robin A. Bertels*
Affiliation:
Department of Pediatric Cardiology, Institution of Data Collection, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Michiel Dalinghaus
Affiliation:
Department of Pediatric Cardiology, Institution of Data Collection, Erasmus Medical Center – Sophia Children's Hospital, Rotterdam, The Netherlands
Maarten Witsenburg
Affiliation:
Department of Pediatric Cardiology, Institution of Data Collection, Erasmus Medical Center – Sophia Children's Hospital, Rotterdam, The Netherlands
Aagje Nijveld
Affiliation:
Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Ad J. J. C. Bogers
Affiliation:
Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
Folkert Meijboom
Affiliation:
Department of Pediatric Cardiology, Institution of Data Collection, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Anton van Oort
Affiliation:
Department of Pediatric Cardiology, Institution of Data Collection, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Ronald Tanke
Affiliation:
Department of Pediatric Cardiology, Institution of Data Collection, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
*
Correspondence to: Dr R. A. Bertels, MD, Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Tel: +31 715262835; Fax: +31 715248110; E-mail: r.a.bertels@lumc.nl

Abstract

Objectives

To evaluate the results of balloon dilatation of stenotic homografts in children, adolescents, and young adults and to identify factors that might influence or predict the effect of the dilatation.

Background

Homografts are widely used in congenital cardiac surgery; however, the longevity remains a problem mostly because of stenosis in the homograft. The effect of treatment by balloon dilatation is unclear.

Methods

In a retrospective study, the effect of balloon dilatation was determined by the percentage of reduction of the peak systolic pressure gradient over the homograft during catheterisation and the postponement of re-intervention or replacement of the homograft in months. Successful dilatations – defined in this study as a reduction of more than 33% and postponement of more than 18 months – were compared with unsuccessful dilatations in search of factors influencing or predicting the results.

Results

The mean reduction of the peak systolic pressure gradient was 30% in 40 procedures. Re-intervention or replacement of the homograft was postponed by a mean of 19 months. In all, 14 balloon dilatations (35%) were successful; the mean reduction was 49% and the mean postponement was 34 months. The time since homograft implantation, the presence of calcification, the homograft/balloon ratio, and the pressure applied during dilatation all tended to correlate with outcome, but were not statistically significant.

Conclusions

Balloon dilatation is able to reduce the peak systolic pressure gradient over homografts in a subgroup of patients and can be of clinical significance to postpone re-intervention or pulmonary valve replacement.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2012

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Footnotes

Currently employed: Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Currently employed: Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.

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