Abstract 3173: Long-term (Up to 18 years) Result of Pulmonary Balloon Valvuloplasty on Regression of Severe Infundibular stenosis and Severe Tricuspid Regurgitation in adults
Background: Significant infundibular stenosis and significant tricuspid regurgitation (TR) occasionally result from severe pulmonary valve stenosis (PS) in adults, and these two conditions have an adverse impact on morbidity and mortality if patients undergo surgery. The aim of the study was (1) to evaluate the long-term outcome of pulmonary balloon valvuloplasty (PBV) in adults (2) to evaluate the effect of successful PBV on severe infundibular stenosis and severe TR.
Methods: PBV was performed in 90 patients (49 females, 41 males) mean age 23 ±9; (range: 15–54) years with congenital pulmonary valve stenosis. Clinical and Doppler echocardiography follow-up was performed for 4 - 18 (mean 10 ± 4.9) years after PBV repeat cardiac catheterization was performed in 53 patients 1–2 years after PBV.
Results: There were no immediate or late deaths. The mean catheter peak pulmonary gradient (PG) before and immediately after PBV, and at intermediate follow-up was 105 ± 3, 34 ± 26 (p <0.0001) and 17 ± 14 (p < 0.0001) mm Hg, respectively. The corresponding values for right ventricular pressure were 125 ± 38, 59 ± 21 (p <0.0001) and 42 ± 12 (p <0001) mm Hg, respectively. The infundibular gradient immediately after PBV was 31 ± 23 mm Hg and it regressed at intermediate follow-up to 14 ± 9 mm Hg (p < 0.0001), whilst cardiac index improved from 2.68 ± 0.73 to 3.1 ± 0.4 l/min/m2 (p < 0.05) at intermediate follow up. Doppler PG before PBV and at intermediate and long-term follow-up were 91 ± 33 (range 36 – 200) mm Hg, 28 ± 12 (range 10 – 60) mm Hg (p < 0.0001) and 26 ± 11 mm Hg (p = 0.2), respectively. New mild pulmonary regurgitation (PR) was noted in 24 patients (25%) after PBV. Significant TR in seven patients regressed or disappeared after PBV.
Long-term results of PBV in adults are excellent.
Severe infundibular stenosis and severe TR regressed after successful PBV.
Hence, PBV should be considered as the treatment of choice for adult patients with PS even in the presence of severe infundibular stenosis or severe TR.