Assessment of long-term hemodynamic changes following balloon valvuloplasty for pulmonary artery stenosis

Pulmonary artery stenosis (PAS) is a common congenital heart defect with a significant impact on the cardiovascular health of affected patients. Despite advancements in interventional cardiology, the long-term hemodynamic outcomes following balloon valvuloplasty (BV) for PAS remain insufficiently studied, especially in varying clinical and demographic subgroups. This knowledge gap necessitates further investigation. To assess long-term hemodynamic changes in patients with PAS after BV and analyze factors contributing to unsatisfactory outcomes. This single-center retrospective cohort study included 180 patients with PAS who underwent BV at the RSPPMCS named after Acad. V. Vakhidov between 2010 and 2022. Patients were categorized based on PAS type and baseline right ventricular systolic pressure (RVSP). Hemodynamic parameters were assessed using echocardiography and CT angiography. Kaplan-Meier survival analysis evaluated the durability of good and satisfactory outcomes. Statistical comparisons were made using t-tests and multivariate regression analysis, with p-values reported to three decimal places. Among the 180 patients, 144 (80.0%) had isolated valvular PAS, 27 (15.0%) had combined valvular-subvalvular PAS, and 9 (5.0%) had valvular-supravalvular PAS. Initial mean RVSP was 93.4±6.7 mmHg, which decreased significantly to 25.3±3.2 mmHg immediately post-BV (p<0.001). Long-term follow-up was achieved in 58 patients over five years, with mean RVSP stabilizing at 26.2±2.4 mmHg. Kaplan-Meier analysis revealed that 81.0% of patients maintained good outcomes at five years. Predictors of poor outcomes included inadequate balloon-to-annulus ratio (<1.2) and residual gradients ≥50 mmHg. Repeat BV improved outcomes in 100% of re-treated cases. BV demonstrates high efficacy in the long-term management of PAS, with sustained improvement in hemodynamics observed in most patients. Optimal balloon sizing remains critical to reducing residual gradients and ensuring long-term success. Further studies should explore additional predictors of restenosis to refine patient selection and procedural strategies.