Percutaneous balloon pulmonary valvuloplasty

doi:10.1016/0002-9149(83)90026-7

The American Journal of Cardiology

Volume 52, Issue 5, 1 September 1983, Pages 560-562

https://doi.org/10.1016/0002-9149(83)90026-7 Get rights and content

Abstract

Percutaneous balloon pulmonary valvuloplasty (BPV) was performed in 18 consecutive patients with valvular pulmonary stenosis (PS) with no associated cardiac defects. The patients were 11 months to 19 years of age. The balloon was positioned across the pulmonary valve and inflated to pressures of 80, 100, and 120 pounds/square inch (psi). Each inflation lasted approximately 10 seconds. Peak systolic pulmonary valve gradient (ΔP) and cardiac output were measured before and 15 minutes after BPV. There was no change in cardiac output, but all patients had an improved ΔP. The prevalvuloplasty ΔP was 81 ± 31 mm Hg, decreasing to 23 ± 11 mm Hg after BPV (p < 0.01). The right ventricular peak systolic pressure decreased from 106 ± 31 to 50 ± 12 mm Hg (p < 0.01). No pulmonary regurgitation was noted after BPV. The balloons were 12 or 15 mm in diameter, chosen according to the diameter of the pulmonary valve anulus. Pressures of 100 to 120 psi were required to achieve full inflation of the balloons. BPV also was performed in a patient with tetralogy of Fallot. Subsequent total repair provided an opportunity to observe the mechanism of the dilatation. Evidence of a small tear alongside the anterior valve raphe was noted. BPV induced a significant decrease in ΔP and may offer an alternative method for treating PS.

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Cited by (171)

Balloon pulmonary valvuloplasty: A systematic review
2024, Indian Heart Journal
There is conclusive evidence for relief of pulmonary valve obstruction immediately after balloon pulmonary valvuloplasty (BPV) and at follow-up. Development of infundibular obstruction is seen in more severe PS cases and in older subjects. Reappearance of PS was observed in approximately 10 % of patients following BPV. The reasons for recurrence were found to be balloon/annulus ratio less than 1.2 and immediate post-BPV pulmonary valve peak gradients greater than 30 mmHg. Recurrent stenosis is successfully addressed by repeating BPV with lager balloons than used initially. Long-term results revealed continue relief of obstruction, but with development of pulmonary insufficiency, some patients requiring replacement of the pulmonary valve. It was concluded that BPV is the treatment of choice in the management valvar PS and that balloon/annuls ratio used for BPV should be lowered to 1.2 to 1.25. It was also suggested that strategies should be developed to prevent/reduce pulmonary insufficiency at long-term follow-up.
Semilunar Valve Interventions for Congenital Heart Disease: JACC State-of-the-Art Review
2021, Journal of the American College of Cardiology
Citation Excerpt :
Balloon pulmonary valvuloplasty (BPV) for PS was introduced in 1982 (4). A number of early studies demonstrated acute relief of right ventricular outflow tract (RVOT) obstruction with few complications in both pediatric and adult patients (5–9). In the current era, BPV has largely supplanted surgical pulmonary valvotomy as the first-choice therapy for PS.
Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has been refined in an effort to optimize acute outcomes while reducing the long-term need for reintervention and valve replacement. Balloon pulmonary valvuloplasty is considered first-line therapy for pulmonary valve stenosis and generally results in successful relief of valvar obstruction. Larger balloon to annulus (BAR) diameter ratios can increase the risk for significant valvar regurgitation. However, the development of regurgitation resulting in right ventricular dilation and dysfunction necessitating pulmonary valve replacement is uncommon in long-term follow-up. Balloon aortic valvuloplasty has generally been the first-line therapy for aortic valve stenosis, although some contemporary studies have documented improved outcomes following surgical valvuloplasty in a subset of patients who achieve tri-leaflet valve morphology following surgical repair. Over time, progressive aortic regurgitation is common and frequently results in the need for aortic valve replacement. Neonates with critical aortic valve stenosis remain a particularly high-risk group. More contemporary data suggest that acutely achieving an aortic valve gradient <35 mm Hg with mild aortic regurgitation may improve long-term valve performance and reduce the need for valve replacement. Continued study will help to further improve outcomes and reduce the need for future reinterventions.
Recent review of transcatheter closure of atrial septal defect
2018, Kaohsiung Journal of Medical Sciences
Citation Excerpt :
King and Mills demonstrated the feasibility of ASD closure by using a device in 1974 [2]. Since the application of balloon dilation treatment for congenital pulmonary stenosis and aortic stenosis in the early 1980s, interventional therapies for congenital heart diseases have developed rapidly including patent ductus arteriosus, atrial septal defect and ventricular septal defect [3,4]. The Amplatzer ASD occluder is a self-expandable, double-disc device with a short connecting waist in the middle that was first made from a nitinol wire with mash in 1997.
Atrial septal defect (ASD) is one of the two most common congenital heart diseases in children and adult. After the application of catheter intervention for ASD, this became an alternative treatment other than surgery from late 1990. In 2001, the procedure was further approved by the US Food and Drug Administration (FDA), and become the first choice for most cases of secundum type of ASD worldwide. The success rate is more than 98% in literature reviews, with low complication rates in percutaneous ASD closure. Major complications are around 1%, including device embolization, cardiac erosions, new-onset atrial arrhythmia, and other comorbidities. We reviewed indications for percutaneous secundum type ASD closure, technique, successful rate and major complications in this article. To complete the catheter intervention with difficult ASD conditions, various procedural techniques have been developed recently. We also report a challenging case by a current balloon-assisted technique for huge ASD closure.
Balloon valvuloplasty for critical pulmonary valve stenosis in newborn: A single center ten-year experience
2016, Progress in Pediatric Cardiology
Citation Excerpt :
In the past decade, balloon pulmonary valvuloplasty (BPV) became the standard of management for this lesion [1–3]. BPV was first described in 1983 [9,10] and is considered relatively less invasive with a lower risk of complications and death compared to surgery [5,6]. This work aimed to evaluate the immediate, short and medium term results, and follow-up, of percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis of neonates in Paediatric Cardiology Unit, Children Hospital, Mansoura University with ten years' experience.
Critical pulmonary stenosis (CPS) represents an emergency in neonates. Percutanous balloon pulmonary valvuloplasty (BPV) is now the first therapeutic option. The study present our experience between April 2003 and June 2013. We analyzed 72 patients with CPS and they were followed up from 18 months to 9 years. BPV was accomplished in 68 neonates. Arterial oxygen saturation significantly elevated after the procedure. There were significant reductions in peak-to-peak pressure gradient across the pulmonary valve. 2 patients had hemopericardium. PGE1 was continued because the right ventricle showed a dynamic RV outflow tract obstruction (RVOTO) in 7 patients. Two patients had PDA stent placement. Follow-up revealed a mean transpulmonary systolic gradient of < 35 mm Hg. 7 patients required a second balloon dilatation with good results. These findings suggest that BPV is relatively safe and effective in neonates with CPS.
Relation of aortic valve morphologic characteristics to aortic valve insufficiency and residual stenosis in children with congenital aortic stenosis undergoing balloon valvuloplasty
2016, American Journal of Cardiology
Citation Excerpt :
However, it is unlikely that technical factors explain all the variation in outcomes after BAV. During balloon dilation of the aortic valve, a tear is introduced into the aortic valve at its weakest point—either along a line of commissural fusion (raphe) or into the valve leaflet itself.18–20 Thus, although the size and type of balloon catheter may play a role in postvalvuloplasty outcomes, characteristics of the valve itself are of great importance.
Aortic valve morphology has been invoked as intrinsic to outcomes of balloon aortic valvuloplasty (BAV) for congenital aortic valve stenosis. We sought to use aortic valve morphologic features to discriminate between valves that respond favorably or unfavorably to BAV, using aortic insufficiency (AI) as the primary outcome. All patients who underwent BAV at 2 large-volume pediatric centers from 2007 to 2014 were reviewed. Morphologic features assessed on pre-BAV echo included valve pattern (unicuspid, functional bicuspid, and true bicuspid), leaflet fusion length, leaflet excursion angle, and aortic valve opening area and on post-BAV echo included leaflet versus commissural tear. Primary end point was increase in AI (AI+) of ≥2°. Eighty-nine patients (median age 0.2 years) were included in the study (39 unicuspid, 41 functional bicuspid, and 9 true bicuspid valves). Unicuspid valves had a lower opening area (p <0.01) and greater fusion length (p = 0.01) compared with functional and true bicuspid valves. Valve gradient pre-BAV and post-BAV were not different among valve patterns. Of the 16 patients (18%) with AI+, 14 had leaflet tears (odds ratio 13.9, 3.8 to 50). True bicuspid valves had the highest rate (33%) of AI+. On multivariate analysis, leaflet tears were associated with AI+, with larger opening area pre-BAV and lower fusion length pre-BAV. AI+ was associated with larger pre-BAV opening area. Gradient relief was associated with reduced angle of excursion. Valve morphology influences outcomes after BAV. Valves with lesser fusion and larger valve openings have higher rates of leaflet tears which in turn are associated with AI.
Interventional techniques
2010, Paediatric Cardiology

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Congenital heart diseasePercutaneous balloon pulmonary valvuloplasty

Abstract

Am Heart J

Am J Cardiol

Transluminal treatment of arteriosclerotic obstruction: description of a new technique and a preliminary report of its application

Circulation

Nonoperative dilatation of coronary artery stenosis: percutaneous transluminal coronary angioplasty

N Engl J Med

Percutaneous transluminal dilation of the renal arteries: techniques and results

Radiology

Long-term results of transluminal angioplasty of the iliac and femoral arteries

Arch Surg

Congenital heart disease
Percutaneous balloon pulmonary valvuloplasty