Circulation, Vol 89, 1751-1759, Copyright © 1994 by American Heart Association
BW McCrindle
BACKGROUND: This study was performed to determine independent predictors of
long-term outcome after percutaneous balloon dilation of congenital
pulmonary valve stenosis. Smaller follow-up series of patients after
balloon pulmonary valvuloplasty have shown inconsistent results regarding
the independent relation between prognostic factors and long-term outcome,
as many patient selection and technical factors are correlated. METHODS AND
RESULTS: Follow-up data were obtained for 533 patients from 22 institutions
at up to 8.7 years after an initial balloon pulmonary valvuloplasty.
Patients were grouped based on defined long-term outcomes, and the
independent effects of patient selection and technical factors were sought
in multivariate statistical analyses. At follow-up, 23% of patients were
noted to have an outcome judged to be suboptimal because of either a
residual right ventricle to pulmonary artery peak systolic gradient of >
or = 36 mm Hg or further treatment of pulmonary stenosis requiring repeat
balloon pulmonary valvuloplasty or surgical therapy. Significant
independent predictors of a suboptimal long-term outcome included an
earlier study year of the initial valvuloplasty (adjusted odds ratio, 0.71
per consecutive year), a small valve hinge point diameter (0.81 per 1-mm
increase), and a higher immediate residual gradient (1.32 per 10 mm Hg
increase). A smaller ratio of balloon to valve hinge point diameter
significantly predicted suboptimal outcomes for patients with valve
morphologies classified as typical (0.52 per 0.1 increase in ratio) and
complex (primarily postsurgical valvotomy, 0.43) but not for patients with
dysplastic (0.95) or combined morphologies (dysplasia with commissural
fusion, 1.01). Patient age, the presence of Noonan's syndrome or associated
cardiac lesions, pre-balloon valvuloplasty hemodynamic parameters, and the
use of a simultaneous double-balloon technique did not independently
predict follow-up outcomes. CONCLUSIONS: Accurate prognostication after
balloon pulmonary valvuloplasty depends on the careful determination of
valvar anatomy. The use of an appropriate ratio of balloon to valve hinge
point diameter in the setting of typical valve morphology will optimize the
chance of long-term success.
ARTICLES
Independent predictors of long-term results after balloon pulmonary valvuloplasty. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators
Department of Pediatrics, University of Toronto Faculty of Medicine, Hospital for Sick Children, Ontario, Canada.
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