Clinical analysis of percutaneous balloon pulmonary valvuloplasty for pulmonary stenosis complicated with subravalvular pulmonary stenosis and supravalvular pulmonary stenosis in children

Abstract:

Objective：To evaluate the clinical efficacy of percutaneous balloon pulmonary valvuloplasty（PBPV） for pulmonary stenosis（PS） complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis. Methods：A total of 45 patients of pulmonary stenosis complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis，who encountered in author’s hospital during past 10 years，were enrolled in this study. The diagnosis was conformed by clinical manifestations，electro－cardiograph（ECG），X-ray，echocardiography. The valve ring size，valvular area，pulmonary valve differential pressure were confirmed before the PBPV. The balloon with the diameter（20％-40％） bigger than the valve ring was confirmed. After the PBPV，the PA-RV （pulmonary artery-right ventricle） pressure was measured immediately. The pulmonary valve open，ECG，pulmonary valve and tricus－pid valve regurgitation were checked. Results：Among 45 cases of pulmonary stenosis complicated with subvalvular pulmonary stenosis （mild） and supravalvular pulmonary stenosis，42 cases had successful intervention，with the success rate of 93.333％. In the pul－monary stenosis complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis group，preoperative and postoperative pulmonary transvalvular pressure gradient was statistically significant（P＜0.05）. In pulmonary stenosis complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis，preoperative and postoperative pulmonary transvalvular pressure gradient was statistically significant（P＜0.05）. Conclusion：When the blood flow velocity of right ventricular outflow tract is less than 3.810 m/s，PBPV is the effective treatment for subvalvular pulmonary stenosis（mild）. PBPV is safe and effective for pulmonary stenosis complicated with supravalvular pulmonary stenosis（the diameter of supravalvular pulmonary stenosis is larger than 5 mm）. In pulmonary stenosis complicated with subvalvular pulmonary stenosis （mild） and supravalvular pulmonary stenosis，PBPV is effective when the pulmonary valve ring is well developed or mild-to-moderate maldeveloped.