M Juárez Rodríguez, C Alva Espinosa, M Ledesma Velasco, G Lázala Rodríguez, S Jiménez Arteaga, A Sánchez Soberanes, J Ortegón Cardeña, F David Gómez, M Hernández González, J Magaña Serrano

Language: Spanish
References: 17
Page: 190-196
PDF size: 92.43 Kb.

ABSTRACT

Objective: To evaluate 15 years of experience with balloon pulmonary valvuloplasty in a single third level health care center. Material and methods: Hundred-fifty patients underwent the procedure, 73 (48%) men and 77 (52%) women, mean age 10.5 ± 11.3 years. Results: The initial systolic gradient decreased from 86 ± 35 to 21.67 ± 12.20 mm Hg, p < 0.001, whereas the initial right ventricular systolic pressure decreased from 106 ± 34-8 to 53 ± 27 mm Hg, p < 0.0001. At the end of the follow-up, 48 ± 44 months, the systolic gradient was 13.43 ± 8.73 mm Hg, p < 0.001. Major complications occurred in 9 (6.4%) patients. Immediate technical success was achieved in 111 (74%) patients and failure in 39 (26%). At the end of the follow-up period, successful outcomes were achieved in 104 (89.6%); in contrast, failures were present in 12 (10.4%) patients, p < 0.001. Death occurred in 2 (1.33%) patients. The predictors for failure were age < 1.5 ± 1-33 years (p < 0.004), dysplastic valve (p < 0.001), high initial systolic gradient (p < 0.002), and high initial systolic right ventricular pressure (p < 0.0001). Conclusion: Balloon pulmonary valvuloplasty is an effective, safe, and first choice treatment for congenital pulmonary valve stenosis

REFERENCES

1. Rubio Álvarez V, Limón Lasson R, Soni J: Valvulotomías intracardíacas por medio de un catéter. Arch Inst Cardiol Mex 1953; 3: 183-192.

2. Kan JS, White IR Jr, Michell SE, Gardner TJ: Percutaneus balloon valvuloplasty: A new method for treating congenital pulmonary valve stenosis. New Engl J Med 1982; 307: 540-42.

3. Ledesma Velasco M, Salgado Escobar JL, Munayer Calderon J, Rangel Abúndis A, Núñez Garduño D, Quintero Rodríguez LR, et al: Transcatheter pulmonary valvuloplasty. Arch Inst Cardiol Mex 1986; 56: 243-246.

4. Kan JS, White RI JR, Mitchell SE, Anderson JH, Gardner TJ: Percutaneous transluminal balloon valvuloplasty for pulmonary valve stenosis. Circulation 1984; 69: 554-60.

5. Radtke W, Keane JF, Fellows, KE: Percutaneous balloon valvulotomy of congenital pulmonary stenosis using overside balloons. J Am Coll Cardiol 1986; 8: 909-15.

6. Gil Moreno M, Zabal CC, Fause A, Vázquez AC, Martínez RMA, Buendía HA, et al: Valvulotomía pulmonar con balón, resultados 42 casos. Arch Inst Cardiol Méx 1993; 63: 297-302.

7. Lázaro CJL, Munáyer CJ, Aldana PT, San Luis MR, Maza JG, Ramírez RH, et al: Valvuloplastía pulmonar resultados a largo plazo, experiencia en Centro Médico la Raza. Arch Inst Cardiol Mex 1999.

8. Zeevi B, Keane JF, Fellows, KE: Balloon dilation of critical pulmonary stenosis in the first week of life. J Am Coll Cardiol 1998; 11: 821-24.

9. Colli AM, Perry SB, Lock JE: Balloon dilation of critical pulmonary stenosis in the first month of life. Cath Cardiovasc Diagnos 1995; 34: 23-28.

10. Justo RN, Nykanen DG, Williams WG: Transcatheter perforation of de right ventricular outflow tract as initial therapy for pulmonary valve atresia and intact ventricular septum in the newborn. Cath Cardiovasc Diagnos 1997; 40: 408-13.

11. Fedderly RT, Lloyd TR, Mendelsohn AM: Determinants of successful balloon valvotomy in infants with critical pulmonary stenosis or membranous pulmonary atresia with intact ventricular septum. J Am Coll Cardiol 1995; 25: 460-65.

12. Mccrindle BW: Independent predictors of long-term results after balloon pulmonary valvuloplasty. Circulation 1994; 89: 1751-59.

13. Mendelsohn AM, Baner Jee A, Meyer R, Schwartz DC: Predictors of successful pulmonary balloon valvuloplasty: 10 year experience. Cathet Cardiovasc Diagnos 1996; 39(3): 236-43.

14. Nugent EW, Freedom RM, Nora JJ, Ellison RC, Rowe RD, Nadas AS: Clinical course in pulmonary stenosis. Circulation 1977; 56: 138-147.

15. Rao PS, Fawzy ME, Solymar L, Mardini MK: Long-term results of balloon pulmonary valvuloplasty of valvar pulmonic stenosis. Am Heart J 1988; 115: 1291-1296.

16. Robertson M, Benson LN, Smallhorn JS, Musewe N, Freedom RM, Moes CA, et al: The morphology of the right ventricular outflow tract after percutaneus pulmonary valvotomy: long-term follow-up. Br Heart J 1987; 58: 239-244.

17. Cazzaniga M, Vagnola O, Alday L: Balloon pulmonary valvuloplasty in infants: A quantitative analysis of pulmonary valve-annulus-trunk structure. J Am Coll Cardiol 1992; 20: 345-349.