Management of typical and dysplastic pulmonic stenosis, uncomplicated or associated with complex intracardiac defects, in juveniles and adults: Use of percutaneous balloon pulmonary valvuloplasty with eight‐month hemodynamic follow‐up

To alleviate large fixed right ventricular (RV) outflow gradients, percutaneous balloon dilatation of pulmonic stenosis (PS) was performed in 38 patients with mean age of 14 ± 14 years (median: 9 years, age range: 9 months to 63 years). There were 21 males and 17 females. Thirty‐four patients had typical PS (5 of them also having other complex congenital cardiac anomalies, while 13 additional patients had a patent foramen ovale); 2 further subjects had subpulmonic, and 2 dysplastic pulmonary valvular obstructions. Sixteen patients were in the New York Heart Association (NYHA) Class I, 15 in Class II, 6 in Class III, and 1 in Class IV. Electrocardiographic (ECG) evidence of right ventricular hypertrophy (RVH) was present in 29 patients (76%); 3 patients had right bundle branch block (RBBB). For the entire group, there was a marked decrease in the mean systolic transpulmonic gradient in the immediate post‐valvuloplasty period (from 97 ± 43 to 26 ± 17 mmHg; P < 0.0001). One patient expired 8 hours post‐valvuloplasty (he was in the NYHA Class IV, and had severe RV failure). No other cardiovascular complications were encountered; the median hospital stay was 3 days (range: 1–10 days). At an 8‐month follow‐up, 12 patients who were reevaluated invasively had a median transpulmonic gradient of 27 mmHg (range: 5–92 mmHg) as compared to their pre‐valvuloplasty values of 84 mmHg (range: 49‐142 mmHg; P <0.004). Two patients restenosed; 1 required open‐heart surgical valvulotomy with simple shaving, and 1 had successful redilatation with balloon valvuloplasty. Our results indicate that balloon pulmonary valvuloplasty (BPV) is a safe and effective procedure in most patients with PS. Percutaneous BPV should therefore be currently considered to be an excellent alternative form of treatment for most, if not all, subjects with a significant pulmonic valvular obstruction who might otherwise likely become the prime candidates for a severely compromised hemodynamic status if these defects were not expeditiously corrected.