Key result
High-pressure pulmonary valvotomy salvages low-pressure failures with no significant difference in reintervention rates.
Why the study?
The results of pulmonary valve balloon valvotomy in dysplastic valves are variable, and high-pressure valvotomy may improve success in cases failing low-pressure valvotomy.
Does high-pressure pulmonary valve balloon valvotomy improve success rates and prevent reintervention in patients <3 years old with isolated pulmonary valve stenosis who fail low-pressure valvotomy?
Cohort (n=35)
Does high-pressure pulmonary valve balloon valvotomy improve success rates and prevent reintervention in patients <3 years old with isolated pulmonary valve stenosis who fail low-pressure valvotomy?
High-pressure balloon valvotomy is a safe and effective rescue strategy for young children with isolated pulmonary valve stenosis who fail initial low-pressure balloon valvotomy.
May support high-pressure valvotomy as rescue after low-pressure failure in children <3 years; leaves open need for randomized confirmation.
BACKGROUND: Pulmonary valve (PV) balloon valvotomy (BV) is considered the treatment of choice for isolated pulmonary valve stenosis (IPVS). While immediate and long-term results of PVBV are usually excellent, the reported results in dysplastic valves are variable. High-pressure (HP) PVBV in dysplastic valves that fail low-pressure (LP) PVBV may increase success rate, reducing the need for surgical interventions. METHODS: We reviewed all cases of IPVS in patients <3 years old, who underwent PVBV between August 1999 and March 2004. Study outcomes were initial success rate (gradient post PVBV < 30 mm Hg) and freedom from reintervention. Possible predictors of failure to LP-PVBV were explored (age, hemodynamic data, PV leaflet maximal thickness, diameter/z-scores for PV annulus, sinotubular junction, and subvalvar area). RESULTS: All 35 patients (16 neonates, 5 with critical IPVS) underwent LP-PVBV with immediate success in 27 (80%). All eight patients who failed LP-PVBV successfully underwent HP-PVBV. Upon follow-up (27 +/- 24 months), two patients (6.9%) required reintervention after LP-PVBV (LP-PVBV at 3 months, HP-PVBV at 2 months with success, both reintervention free thereafter), and one patient (12.5%) after HP-PVBV (surgical right ventricular outflow tract patch at 33 months) (Fisher's exact test = 0.5). There were no major immediate or long-term complications. After nonparametric median regression, age (2 vs. 11 months, P < .001) and PV maximal thickness (0.13 vs. 0.24 cm, P= .026) were the only predictors of failure to LP-PVBV. CONCLUSION: HP-PVBV can be performed safely in patients with IPVS that fail LP-PVBV, with high success rate and acceptable long-term results. Failure to LP-PVBV is difficult to predict.
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Moguillansky et al. (2010) conducted a cohort in Isolated pulmonary valve stenosis (n=35). High-pressure pulmonary valve balloon valvotomy vs. Low-pressure pulmonary valve balloon valvotomy was evaluated on Reintervention (p=0.5). High-pressure pulmonary valve balloon valvotomy successfully treated all patients failing low-pressure valvotomy, with no significant difference in reintervention rates (12.5% vs 6.9%, P=0.5).
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