May 15, 2026Journal of the American College of Cardiology25 citations
Semilunar Valve Interventions for Congenital Heart Disease
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Key Result
Transcatheter balloon valvuloplasty is a first-line therapy for pulmonary and aortic valve stenosis, with contemporary data suggesting that achieving an aortic valve gradient <35 mm Hg improves outcomes.
Key Points
- The aim is to evaluate the efficacy of transcatheter balloon valvuloplasty in treating aortic and pulmonary valve stenosis.
- Refinement of balloon valvuloplasty techniques over 40 years.
- Assessment of outcomes regarding valve regurgitation and reintervention rates.
- Analysis of neonatal patients with critical aortic valve stenosis and their treatment outcomes.
- Balloon pulmonary valvuloplasty successfully relieves valvar obstruction in the majority of cases.
- Higher balloon to annulus diameter ratios can increase risk for significant valvar regurgitation.
- Achieving an aortic valve gradient <35 mm Hg acutely improves long-term valve performance.
Structured PICO
What are the outcomes and optimal strategies for transcatheter balloon valvuloplasty in patients with congenital aortic and pulmonary valve stenosis?
P
Population
Patients with congenital heart disease, specifically aortic and pulmonary valve stenosis (including neonates with critical aortic valve stenosis)
I
Intervention
Transcatheter balloon valvuloplasty (pulmonary and aortic)
C
Comparator
Surgical valvuloplasty (in specific subsets)
O
Outcome
Relief of valvar obstruction, development of valvar regurgitation, and long-term need for reintervention or valve replacement
This review highlights that while balloon valvuloplasty is effective first-line therapy for congenital semilunar valve stenosis, optimizing acute gradients and minimizing regurgitation are critical to reducing the long-term need for surgical valve replacement.
Abstract
Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has been refined in an effort to optimize acute outcomes while reducing the long-term need for reintervention and valve replacement. Balloon pulmonary valvuloplasty is considered first-line therapy for pulmonary valve stenosis and generally results in successful relief of valvar obstruction. Larger balloon to annulus (BAR) diameter ratios can increase the risk for significant valvar regurgitation. However, the development of regurgitation resulting in right ventricular dilation and dysfunction necessitating pulmonary valve replacement is uncommon in long-term follow-up. Balloon aortic valvuloplasty has generally been the first-line therapy for aortic valve stenosis, although some contemporary studies have documented improved outcomes following surgical valvuloplasty in a subset of patients who achieve tri-leaflet valve morphology following surgical repair. Over time, progressive aortic regurgitation is common and frequently results in the need for aortic valve replacement. Neonates with critical aortic valve stenosis remain a particularly high-risk group. More contemporary data suggest that acutely achieving an aortic valve gradient <35 mm Hg with mild aortic regurgitation may improve long-term valve performance and reduce the need for valve replacement. Continued study will help to further improve outcomes and reduce the need for future reinterventions.
Cite This Study
Morray et al. (Fri,) conducted a review in Congenital Heart Disease (aortic and pulmonary valve stenosis). Transcatheter balloon valvuloplasty was evaluated. Transcatheter balloon valvuloplasty is a first-line therapy for pulmonary and aortic valve stenosis, with contemporary data suggesting that achieving an aortic valve gradient <35 mm Hg improves outcomes.