Pictorial rendition of author’s observations on balloon valvuloplasty/angioplasty procedures: Pulmonary stenosis

Balloon valvuloplasty/angioplasty techniques have been available to address valvar and vascular obstructions associated with congenital heart defects (CHDs) since the 1980s. The objective of this paper is to provide a pictorial rendition of the author’s observations over the last four decades on these techniques. In this paper, balloon pulmonary valvuloplasty (BPV) for treating isolated pulmonary stenosis (PS), PS associated with cyanotic CHDs, and bioprosthetic valve in the pulmonary position were reviewed. Balloon dilatation leads to a decrease in the peak systolic pressure gradient through the pulmonary valve during BPV, as well as at intermediate-term and long-term evaluation. Problems, such as the reappearance of obstruction at intermediate-term follow-up and pulmonary insufficiency (PI) at long-term follow-up, have been documented in isolated PS cases but are infrequent. Repeat balloon valvuloplasty for restenosis has been successfully used. The development of infundibular obstruction in PS cases was also reviewed. To decrease the frequency and degree of PI, the author has revised the recommendations for balloon/annulus ratios used for BPV from the previous 1.2 – 1.4 to 1.2 – 1.25. In patients with PS associated with cyanotic CHD, improvement of oxygen saturations at the time of BPV and enhanced anatomy during follow-up were observed. BPV of bioprosthetic valves results in minimal improvement in the pulmonary valve gradient, and stents may be a better alternative to address this problem.