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Long-term results of percutaneous balloon valvuloplasty in neonatal critical pulmonary valve stenosis: a 20-year, single-centre experience

Published online by Cambridge University Press:  16 June 2017

Petra Loureiro ,
Barbara Cardoso ,
Inês B. Gomes ,
José F. Martins  and
Fátima F. Pinto
Petra Loureiro*
Affiliation:
Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Lisbon, Portugal
Barbara Cardoso
Affiliation:
Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Lisbon, Portugal
Inês B. Gomes
Affiliation:
Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Lisbon, Portugal
José F. Martins
Affiliation:
Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Lisbon, Portugal
Fátima F. Pinto
Affiliation:
Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Lisbon, Portugal
*
Correspondence to: P. Loureiro, MD, Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 1169 024 Lisbon, Portugal. Tel: +351 21 359 4332; Fax: +351 21 359 4034; E-mail: petra.loureiro@gmail.com
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Abstract

Introduction

Percutaneous balloon valvuloplasty is the primary treatment for critical pulmonary valve stenosis in neonates. Thus far, a few studies have reported long-term results of this technique in neonatal critical pulmonary valve stenosis.

Methods

We carried out a retrospective study of all consecutive newborns with critical pulmonary valve stenosis subjected to percutaneous balloon valvuloplasty at a single centre, between 1994 and 2014, to assess its immediate and long-term safety and efficacy.

Results

A total of 24 neonates presented with critical pulmonary valve stenosis. The mean diameter of the pulmonary annulus was 7 mm (±1.19); 33.3% had a dysplastic pulmonary valve, and 92% were started on prostaglandin E1 treatment. Percutaneous balloon valvuloplasty was performed at a mean age of 4.0±4.3 days using, on average, a balloon-to-pulmonary annulus ratio of 1.18 mm (with a range from 0.9 to 1.43). Immediate success was achieved in 22/24 patients (92%) with a reduction in the pulmonary transvalvular peak gradient (p<0.05) and in the right ventricle/systemic pressure ratio (p<0.05). There was one death (4%) 6 days after the procedure, and 29.2% of them had transient rhythm complications. For a mean follow-up time of 8.4 years, the re-intervention rate was 42.9%. In total, 14 re-interventions were performed in nine neonates, including surgery in six. Freedom from re-intervention was 50% at 8 years and 43% at 10 and 15 years.

Conclusion

This series, to the best of our knowledge, has had the longest follow-up of neonates with critical pulmonary valve stenosis. Percutaneous balloon valvuloplasty is a safe and effective treatment, and in our study 75% of the patients were exclusively treated using this technique.

Keywords

Critical pulmonary valve stenosispercutaneous balloon valvuloplastypatent ductus arteriosusneonate
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1314 - 1322
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Copyright
© Cambridge University Press 2017 

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