Balloon valvuloplasty in dysplastic pulmonary valve stenosis: immediate and intermediate outcomes.

Objective: To determine the immediate and intermediate outcome in dysplastic and doming pulmonary valve stenosis in children and to determine various factors associated with unsuccessful outcome.

Study Design: An interventional study.

Place And Duration Of Study: The Children's Hospital, Lahore, Pakistan, from June 2006 to December 2012.

Methodology: All patients presenting with severe pulmonary valve stenosis were enrolled in the study. Balloon valvuloplasty was performed on all patients. Successful outcome (residual gradient < 36 mmHg) was compared with matched doming pulmonary valve stenosis control group valvuloplasty. Difference in various quantitative variables was calculated using independent t-test and Mann Whitney U test. Categorical variables were compared using Chi square and Kruskal-Wallis test. Multivariate analysis was performed to determine various factors associated with outcome. Kaplan- Meier survival table was used to determine freedom from re-intervention proportions.

Results: One hundred and fifty two patients (Dysplastic group A, n=73; Doming group B, n=79) with median age of 24 months (range 3 - 192 months) and M:F; 2:1 were included in the study. Mean gradient decreased from 96 ± 33 mmHg to 29 ± 20 mmHg. Group A had significantly higher number of patients with unsuccessful outcome (9.6%, p=0.02). Preprocedure gradient > 75 mmHg was the most significant factor associated with unsuccessful outcome (p < 0.001). Median follow-up duration was 3 years (range 1 - 6 years). Freedom from re-intervention proportion at 1, 3 and 6 years was 91.3%, 86.7% and 78.9% respectively in group A compared to 100%, 96.5% and 96.5% respectively in group B. Immediate postprocedure gradient > 60 mmHg was the only significant factor associated with re-intervention in group A (p=0.001).

Conclusion: The results from balloon valvuloplasty in dysplastic pulmonary valve were suboptimal when compared to doming valves. However, it provides a high freedom from re-intervention rate in intermediate follow-up. Intervention at moderate severity can result in better outcome.