Pulmonary congestion after percutaneous balloon pulmonary valvuloplasty in children with isolated pulmonary stenosis

Background Percutaneous balloon pulmonary valvuloplasty (PBPV) is the standard treatment for significant pulmonary stenosis (PS). Pulmonary reperfusion injury has been described in case reports, but the frequency and clinical significance of postprocedural pulmonary congestion in children with isolated PS remain unclear. Objective To determine the rate and early clinical significance of pulmonary congestion after PBPV in children with isolated PS. Methods We retrospectively studied children admitted for observation after PBPV between January 2005 and March 2023. We excluded patients with structural cardiac lesions that could increase pulmonary blood flow and neonates with critical PS requiring prostaglandin to maintain ductal patency. Children were compared according to the presence or absence of pulmonary congestion on postprocedural chest radiography (CXR). Results Among 154 children, median age was 3.5 months (IQR, 1.5–12.0) and median weight was 5.75 kg (IQR, 4.0–8.5). Pulmonary congestion was identified in 20 patients (13%). Baseline characteristics, stenosis type, and gradient reduction were similar between groups. Children with pulmonary congestion were more likely to arrive in the pediatric intensive care unit invasively ventilated (25% vs 8%; p = 0.038) and to remain there for more than 24 h (25% vs 3.7%; p = 0.004). Conclusion Pulmonary congestion occurred after 13% of pediatric PBPV procedures and was associated with a more complicated early postprocedural course despite no obvious preprocedural predictors. These findings support careful early surveillance after PBPV.