Long-term results (up to 17 years) of pulmonary balloon valvuloplasty in adults and its effects on concomitant severe infundibular stenosis and tricuspid regurgitation

Abstract

Background: Significant infundibular stenosis and significant tricuspid regurgitation (TR) occasionally result from severe pulmonary valve stenosis in adults, and these 2 conditions have an adverse impact on morbidity and mortality in patients who undergo corrective surgery. The goal of this study was (1) to evaluate the long-term (up to 17 years) outcome of pulmonary balloon valvuloplasty (PBV) in adults and (2) to determine the effect of successful PBV on severe infundibular stenosis and severe TR.

Methods: Pulmonary balloon valvuloplasty was performed in 90 consecutive patients (49 women, 41 men) of mean age 23 +/- 9 years (range 15-54 years) with congenital pulmonary valve stenosis. Clinical and echocardiographic assessment was performed 2 to 17 years (mean 10 +/- 3.9 years) after PBV. Repeat cardiac catheterization was performed 6 to 24 months after PBV in 43 patients who had concomitant moderate to severe infundibular stenosis (infundibular gradient > or = 30 mm Hg).

Results: There were no immediate or late deaths. The mean catheter peak pulmonary gradient (gradient between pulmonary artery and right ventricular body) before and immediately after PBV was 105 +/- 39 and 34 +/- 26 (P < .0001), respectively. The corresponding values for right ventricular pressure were 125 +/- 38 and 59 +/- 21 mm Hg (P < .0001), respectively. The infundibular gradient (in 43 patients) immediately after PBV was 42.9 +/- 24.8 (30-113) mm Hg, and it regressed at second catheterization to 13.5 +/- 8.3 mm Hg (P < .0001), whereas cardiac index improved from 2.68 +/- 0.73 to 3.1 +/- 0.4 L min(-1) m(-2) (P < .05). Doppler pulmonary gradient before PBV and at 1-year and long-term follow-up were 91 +/- 33 (range 36-200), 28 +/- 12 (range 10-60) (P < .0001), and 26 +/- 11 (range 7-60) mm Hg (P = .2), respectively. New mild pulmonary regurgitation was noted in 24 patients (28%) after PBV. Significant TR in 7 patients either regressed or disappeared after PBV.

Conclusions: Long-term results of PBV in adults are excellent. Severe infundibular stenosis and severe TR regressed after successful PBV. Therefore, PBV should be considered as the treatment of choice for adult patients with valvular pulmonary stenosis even in the presence of severe infundibular stenosis or severe TR.