Abstract 19567: Severe Pulmonary Insufficiency is Common > 10 Years Following Balloon Pulmonary Valvuloplasty for Isolated Pulmonary Valve Stenosis
Introduction: While balloon pulmonary valvuloplasty (BPV) for isolated pulmonary stenosis successfully relieves obstruction acutely, long term outcomes remain unclear, with only one study to date exclusively reporting >10 year outcomes (n=48 subjects). We evaluated the long-term incidence of ≥moderate pulmonary insufficiency (PI) and reintervention.
Methods: Patients undergoing BPV at our institution from 1982-2002 for isolated pulmonary valve stenosis (n=211) were eligible for inclusion. Long-term follow-up data were available for 103 patients (primarily those followed at our center). Incidence of ≥moderate PI and reintervention were reported and risk factors for ≥moderate PI assessed in univariate and multivariable analysis.
Results: Of 103 included patients, age at initial BPV was 0.7 yrs (range 1d-42.2 years), BSA 0.38 m2 (range 0.14-1.99 m2), peak cath gradient 65 mmHg (range 31-169 mmHg) and 23% had critical pulmonary stenosis. In the first 10 years after BPV, 16% had surgical pulmonary valvotomy, transannular patch, or BT shunt and 2% died. Of the remaining patients with >10-year follow up data (median follow-up 15.1 years, range 10.1-26.3 years), 62 had a recent echocardiogram. Of these patients, 37% had moderate and 23% had severe PI; RV dilatation was mild in 32% and moderate in 10%, while 5% had mild RV systolic dysfunction. Three patients had pulmonary valve replacement 16.8-22.2 yrs following BPV due to severe PI. In univariate analysis, critical pulmonary stenosis, younger age, smaller BSA, and smaller pulmonary annulus at the time of BPV, as well as greater pre-BPV cath gradient were associated with ≥moderate PI (all p<0.05). There was no significant association between balloon:annulus ratio and ≥moderate PI. In multivariable analysis, BSA <0.3 m2 remained significantly associated with ≥moderate PI (OR 6.4, 95% CI 1.2-33.6; p=0.03).
Conclusions: In the largest study to date of > 10 year outcomes following BPV nearly ¼ of patients developed severe PI. Although few patients have required pulmonary valve replacement to date, close follow up is necessary. Patients with younger age, lower BSA, and/or more severe pulmonary stenosis at the time of BPV have a greater risk of significant PI and should be counseled regarding the long term risks.
Author Disclosures: R. Devanagondi: None. D. Peck: None. J. Sagi: None. J. Donohue: None. S. Yu: None. S.K. Pasquali: None. A. Armstrong: None.
- © 2014 by American Heart Association, Inc.