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European Heart Journal 1991 12(1):15-23;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

R. MELGARES, J. A. PRIETO and J. AZPITARTE

Division of Cardiology, Hospital Virgen de las Nieves Granada, Spain

Received 18 January 1989; revised 12 December 1989; .

Correspondence. Dr J. Azpitarte, Hospital Virgen de las Nieves, Servicio de Cardiologia, Avda. de la Constitucion, 100, 18012 Granada, Spain.

Abstract

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 ± 7.4 to 22.2 ±1.8 mmHg, (P < 0.0001) and follow-up cardiac catheterization at 5.3 ± 0.4 months in 19 patients revealed no further significant change in gradient (23.5 ± 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i. e. an immediate residual transvalvular gradient of 220 ± 2.2 mmHg with a balloon annulus ratio > 1, as opposed to 44.2 ± 5.4 with a balloon/annulus ratio = 1 (P < 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 ±0.09 vs 0.59 ± 0.02 mmHg, P< 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P < 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.

Key Words: Ballon pulmonary valvuloplasty • congenital pulmonary valve stenosis • pulmonary valve dysplasia


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