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Variability of the diameter of the pulmonary outflow tract and its relation to balloon valvoplasty for congenital pulmonary valvar stenosis

  • Roxy N. S. Lo (a1), Maurice P. Leung (a1), T. C. Yung (a1) and C. H. Chan (a1)

Summary

The diameter of the pulmonary outflow tract was measured from the right ventricular cineangiogram at different phases of the cardiac cycle prior to balloon valvoplasty in 54 patients with congenital pulmonary valvar stenosis. Measured at the level of the hinge point of the valvar leaflets, the pulmonary outflow tract was found to be largest at end-diastole and smallest at end-systole. The mean increase in diameter from systole to diastole was 25.3% (range 6–53%) for 47 patients with typical valvar stenosis, and 24.3% (range 14–41%) for seven patients with dysplastic valvar leaflets (p>0.5). Dilatation using balloons less than 1.2 times the size of the maximal end-diastolic diameter produced a mean reduction in the pressure gradient from right ventricle to pulmonary trunk of 71.1%, compared to 76.2% with bigger balloons (p>0.3). Two patients with an initial ratio between balloon and outflow tract of 0.9 required a second dilatation. The timing of measurement of the diameter of the pulmonary outflow tract should be standardized. Oversized balloons probably are not necessary for pulmonary valvoplasty.

Copyright

Corresponding author

Correspondence to Dr. Roxy N. S. Lo, Department of Pediatrics, University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong.

References

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1.Kan, JS, White, RI, Mitchell, SE, Gardner, TJ. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary valve stenosis. New Engl J Med 1982; 307: 540542.
2.Radtke, W, Keane, JF, Fellows, KE, Lang, P, Lock, JE. Percutaneous balloon valvotomy of congenital pulmonary stenosis using oversized balloons. J Am Coll Cardiol 1986; 8:909915.
3.Rao, PS. Further observations on the effect of balloon size on the short-term and intermediate-term results of balloon dilatation of the pulmonary valve. Br Heart J 1988; 60: 507–11.
4.Ballerini, L, Mullins, CE, Cifarelli, A, Pasquini, L, De, Simone G, Giannico, S, Guccione, P, Di Donato, R, Di Carlo, D. Percutaneous balloon valvuloplasty of pulmonary valve stenosis, dysplasia and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum: long-term results. Cath Cardiovasc Diag 1990; 19: 165169.
5.Beekman, RH,Rocchini, AP,Rosenthal, A. Therapeutic cardiac catheterization for pulmonary valve and pulmonary artery stenosis. Cardiol Clinics 1989; 7: 331340.
6.Ladusans, EJ, Qureshi, SA, Parsons, JM, Arab, S, Baker, EJ, Tynan, M. Balloon dilatation of critical stenosis of the pulmonary valve in neonates. Br Heart J 1990; 63: 362367.
7.Sullivan, ID, Robinson, PJ, Macartney, FJ, Taylor, JFN, Rigby, PG, Bull, C, Deanfield, JE. Percutaneous balloon valvuloplasty for pulmonary valve stenosis in infants and children. Br Heart J 1985: 54:435441.
8.Miller, GAH. Balloon valvuloplasty and angioplasty in congenital heart disease. Br Heart J 1985; 54: 285289.
9.Lim, MK, Houston, AB, Doig, WB, Lilley, S, Murtagh, EP. Variability of the Doppler gradient in pulmonary valve stenosis before and after balloon dilatation. Brit Heart J 1989; 62:212216.
10.Marantz, PM, Huhta, JC, Mullins, CE, Murphy, DJ, Nihill, MR, Ludomirsky, A, Yoon, GY. Results of balloon valvuloplasty in typical and dysplastic pulmonary valve stenosis: Doppler echocardiographic follow-up. J Am Coll Cardiol 1988; 12: 476479.
11.Musewe, NN, Robertson, MA, Benson, LN, Smallhorn, SF, Burrows, PE, Freedom, RM, Moes, CAF, Rowe, RD. The dysplastic pulmonary valve: echocardiographic features and results of balloon dilatation. Br Heart J 1987; 57: 364370.
12.Ring, JC, Kulik, TJ, Burke, BA, Lock, JE. Morphologic changes induced by dilation of the pulmonary valve annulus with overlarge balloons in normal newborn lambs. Am J Cardiol 1984; 55: 210214.
13.Kan, JS, White, RI, MitChell, SE, Anderson, JH, Gardner, TJ. Percutaneous transluminal balloon valvuloplasty for pulmonary valve stenosis. Circulation 1984; 69: 554560.
14.Tynan, M, Baker, EJ, Rohmer, J, Jones, DDH, Reidy, JF, Joseph, MC, Ottenkamp, J. Percutaneous balloon pulmonary valvuloplasty. Br Heart J 1985; 53: 520524.
15.Kveselis, DA, Rocchini, AP, Snider, AR, Rosenthal, A, Crowley, DC, Dick, M. Results of balloon valvuloplasty in the treatment of congenital valvar pulmonary stenosis in children. Am J Cardiol 1985; 56: 527532.
16.McCrindle, BW, Kan, JS. Long-term results after balloon pulmonary valvuloplasty. Circulation 1991; 83: 19151922.
17.Schneeweiss, A, Blieden, LC, Shem-Tov, A, Goor, D, Milo, S, Neufeld, HN. Diagnostic angiocardiographic criteria in dysplastic stenotic pulmonic valve. Am Heart J 1983; 106: 761762.
18.Sievers, H, Onnasch, DGW, Lange, PE, Berhard, A, Heintzen, PH. Dimensions of the great arteries, semilunar valve roots, and right ventricular outflow tract during growth: normative angiocardiographic data. Pediatr Cardiol 1983; 4: 189196.
19.Hansens, K, Bjorkhem, G, Lundstrom, N. Dimensions of cardiac chambers and great vessels by cross-sectional echocardiography in infants and children. Pediatr Cardiol 1988;9:715.
20.Gussenhoven, WJ, van Leenen, BF, Kuis, W, Villenevue, VHD, Bom, N, van Woezik, H. Comparison of internal diameter of great arteries in congenital heart disease. A cross-sectional echocardiographic study. Br Heart J 1983; 49: 4550.
21.Ichida, F, Aubert, A, Denef, B, Dumoulin, M, van der Hauwaert, LG. Cross-sectional echocardiographic assessment of great artery diameters in infants and children. Br Heart J 1987; 58: 627634.
22.Snider, AR, Enderlein, MA, Teitel, DF, Juster, RP. Two-dimensional echocardiographic determination of aortic and pulmonary artery sizes from infancy to adulthood in normal subjects. Am J Cardiol 1984; 53: 218224.
23.Anderson, RH, Becker, AE. The fibrous skeleton of the heart. In: Cardiac Anatomy. Gower Medical Publishing, London, 1980, pp 5.25.5.
24.Williams, PL, Warwick, R, Dyson, M, Bannister, LH. Angiology. In: Gray's Anatomy. 37th ed.Churchill Livingstone, Edinburgh, 1989, pp 707719.
25.Grant, RP, Downey, FM, MacMahon, H. The architecture of the right ventricular outflow tract in the normal human heart and in the presence of ventricular septal defects. Circulation 1961:24:223235.
26.Lendrum, BL, Mondkar, AM, Harris, B, Smulevitz, B, Carr, I. Respiratory variation in echocardiograhic dimensions of left and right ventricles in normal children. Pediatr Cardiol 1979; 1:3945.

Keywords

Variability of the diameter of the pulmonary outflow tract and its relation to balloon valvoplasty for congenital pulmonary valvar stenosis

  • Roxy N. S. Lo (a1), Maurice P. Leung (a1), T. C. Yung (a1) and C. H. Chan (a1)

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