Balloon valvuloplasty of pulmonary stenosis in infants and children — Co-operative study of the German Society of Pediatric Cardiology

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Abstract
Balloon valvuloplasty (BVP) of pulmonary stenosis (PST) was performed in 305 infants and children in 20 heart centres of the Federal Republic of Germany. 273 patients suffered from isolated PST. Their age ranged from 3 days to 18 years (mean = 5.85 ±4.82 years), their weight from 2.9 to 60 kg. The pressure gradient was measured invasively in the sedated or anaesthetized child, partly by CW Doppler. BVP was performed by mono- or trefoil catheters, mostly oversized. As a result, mean pressure gradient fell from 71.7±32mmHg before to 31.8±25 mmHg immediately after BVP(P< 0.0001). The gradient was reduced by <30% in 13% of the patients, by 30–49% in 23%, and by ≥50% in 64%. Among 33 patients with a gradient reduction of <30%, nine were aged <1 year, nine had dysplastic valves, and nine had a short-term infundibular reaction and good late results. Gradient reduction was not improved with oversized balloons and was independent of the initial gradient. Follow-up for a mean 11.2±8 months showed a further slight improvement, probably due to regression of infundibular hypertrophy. In the whole group we observed infundibular reaction in 12%, serious complications with one late death in 4%. From the start, BVP proved to be a secure and effective tool for elimination of pulmonary stenosis.