The Immediate and Intermediate Term Follow Up of Patients with Critical Pulmonary Valve Stenosis after Balloon Valvuloplasty

, Hassan Yousif Al-Najjar; , Firas Sadeq Abdul Kareem; , Hammood Naser Mohsin; , Hussein A. Alwahab

	The Immediate and Intermediate Term Follow Up of Patients with Critical Pulmonary Valve Stenosis after Balloon Valvuloplasty
Iraqi Postgraduate Medical Journal
Article 1, Volume 18, Issue 2, 2019, Pages 87-95 PDF (0 K)
Authors
Hassan Yousif Al-Najjar; Firas Sadeq abdul kareem; Hammood Naser Mohsin; Hussein A. Alwahab
Abstract
ABSTRACT: BACKGROUND: Balloon pulmonary valvuloplasty (BPV) represents the standard of management for all patients with severe pulmonary valve stenosis (PS) irrespective of their age. Nevertheless , neonates and infants with critical PS represent an emergency and a high risk group that needs to be studied. OBJECTIVE: To evaluate results ,complications and follow up of BPV in neonates and infants with critical PS. PATIENTS AND METHODS: During the period extending from February 2010 to February 2011, 25 neonates and infant patients with critical PS were subjected to detailed history taking, full clinical examination, resting 12-lead ECG, chest x-ray and transthorasic echocardiography.BPV was attempted in all patients .Full echocardiographic evaluation was done 24 hour after the procedure as well as 3 and 6 months later. RESULTS: Twenty five patients with critical PS with a mean age of 32.7 ± 21.9 days were subjected to BPV .Immediately after the procedure , patients had a significant reduction of the right ventricular systolic pressure (RVSP) from a mean of 103.96 ± 24.98 mmHg to a mean of 43.6 ± 13 mmHg . The immediate success rate(defined as the drop in the RVSP to less than or equal to 50% of the baseline measurement) was achieved in 76% of cases . Throughout a follow up period of six months, there was a progressive decline in the pressure gradient (PG) across the PV by Doppler echocardiogram from a mean of 93.3 ± 18.2 mmHg to a mean of 17.4 ± 10.42 mmHg. The oxygen saturation increased from 80 ± 8% to 96 ± 2% . There was a significant increase in the mean PV annulus diameter after balloon dilatation from a mean value of 7.1 ± 1.9 mm to a mean value of 9.3 ± 1.1 mm. The incidence of pulmonary incompetence (PI) significantly increased immediately after BPV to 66.6% followed by a progressive decline over a 6 months period of follow up to 19% . Over the same period of follow up , there was a significant decrease in the incidence of tricuspid regurgitation (TR) from 32% to 9.5% . There were complications including three deaths (12%).One patient was referred to surgery (4%) and two had developed significant re stenosis (8%) . CONCLUSION: BPV is safe and effective procedure to relieve critical PS in neonates and infants that should be done as early as possible .
Keywords
Critical Pulmonary Valve Stenosis Balloon Pulmonary Valvuloplasty

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