Percutaneous Balloon Valvuloplasty in Severe Pulmonary Valvular Stenosis

Percutaneous balloon pulmonary valvuloplasty (PBPV) was achieved successfully in 20 of 22 patients with severe pulmonary valvular stenosis, aged two days to ten years (median four years and two months). The diameters of the balloon for PBPV were 88-125% (mean ±SD=109.5 ±10.0%) of the pulmonary valve annulus. PBPV failed in 2 patients because of the inability of the cardiac catheters to cross the stenotic valve. A significant reduction of right ventricle-pulmonary artery (RV-PA) pressure gradient occurred in all 20 patients (mean ±SD=72.1 ±10.3%). The mean RV-PA pressure gradient was reduced from 93.2 ±33.1 to 26.3 ± 15.6 mmHg (P < 0.0001) and the mean right ventricular peak systolic pressure fell from 117.2 ±32.4 to 51.6 ±17.3 mmHg (P < 0.0001). Five (25%) of 20 patients had an infundibular gradient before PBPV. Two (10%) developed a new infundibular stenosis immediately after PBPV. Four (20%) presented with cyanosis, which disappeared after the successful PBPV. Two patients (10%) who showed a residual RV- PA pressure gradient of more than 40 mmHg had a significant infundibular obstruction initially. Two patients underwent recatheterization fifteen months after PBPV owing to a significant residual RV-PA pressure gradient and had no reductions in right ventricular pressure and RV-PA pressure gradient, but resolution of infundibular obstruction was noted in both. Repeat PBPV was successfully performed on these 2 patients. No significant complications were noted in any patient. It is concluded that PBPV with a balloon diameter of 88-125% of the pulmonary valve annulus is the first choice to treat a patient with severe pulmonary valvular stenosis, even in early infancy.