Exercise Stress Echocardiography–Guided Balloon Pulmonary Valvuloplasty for Pulmonary Valve Stenosis With a Moderate Pressure Gradient and Exercise Intolerance: A Case Report

Figures

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  Figure 1. Echocardiographic findings at rest. (A) Apical four‐chamber view showing right atrial enlargement. (B) Parasternal short‐axis view demonstrating turbulent flow across the pulmonary valve. (C) Systolic dome‐shaped morphology of the pulmonary valve consistent with valvular stenosis.

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  Figure 2. Preprocedural imaging and interventional procedure. (A) Contrast‐enhanced computed tomography acquired during systole demonstrated a 21‐mm pulmonary valve annulus (white arrowheads), without calcification or evidence of supravalvular or subvalvular stenosis or focal narrowing of the right ventricular outflow tract. (B) Post‐stenotic dilatation of the main pulmonary artery. (C) Initial balloon pulmonary valvuloplasty using a single 22‐mm balloon (2 atm), which resulted in a residual pressure gradient. (D) Subsequent double‐balloon dilation with two 16‐mm balloons inflated simultaneously (2 atm each), achieving more effective valvular expansion and a substantial reduction in the pressure gradient. (E) Final pulmonary angiography showing only mild pulmonary regurgitation.