The Medium-and Long-term Follow-up Study Of Percutaneous Balloon Pulmonary Valvuloplasty In Patients With Congenital Pulmonary Stenosis

ObjectivesThe incidence of pulmonary stenosis（PS） has been reported in8%-10%of allpatients with congenital heart disease（CHD）, which is considered to be one of themost commom congenital heart disease.The short-and mid-term results ofpercutaneous balloon pulmonary valvulo-plasty （PBPV） have been so good thatnowadays it has become the preferred method of therapy for PS.The immediateresults and the short-and medium-term follow-up of PBPV have already been welldocumented in the literature. However, reports on long-term follow-up are stilllimited. The purpose of this study is to report the immediate-and long-term resultsof PBPV in our institution, and to analyze the risk actors that influence the effectsof the procedure.MethodsThis study comprised203patients（118males） with PS （including2patients withPA/IVS） undergoing percutaneous balloon pulmonary valvuloplasty from1987toJune2011in our hospital,whose age is ranged from3months to40years（mean4.27±4.16years）.We retrospective analyzed the data before and after thePBPV，which included main clinical symptoms, signs, electrocardiograms （ECG）,transthoracic Doppler Echocardiography （TTE）, the parameters in the PBPV and thefollow-up information.All the patients were divided into three groups，includingmild、moderate and severe，acrroding to the PTG measured by right cardiac catheterization.The procedure was classified as "excellent" when the PTG wasreduced to levels≤25mmHg,"good" when the PTG was reduced to levels25-50mmHg, and "poor" when the≥50mmHg mmHg after procedure. Every patientwho underwent successful PBPV was followed up clinically and by ECG andechocardiogram at1，3，6，12months during the first year and every other year.ResultsOf the203patients,66（32.5%） were symptomatic,46（22.7%）were cyanosedand all of them had a systolic2/6～4/6murmur at pulmonary valve region，and78（38.4%）of them had been touched the thrills on the place of pulmonaryvalve.Electrocardiogram showed right ventricular hypertrophy in178patients（87.8%）、incomplete right bundle branch block in11（5.4%）and right atriumdilation in48（23.6%）.Immediate result200patients succeeded, the technicalsuccessful rate was98.5%.After the procedure, the peak-to-peak pulmonarytransvalvular gradient （PTG） and the right ventricular systolic pressure significantlydecreased （P<0.01）, and the pulmonary systolic pressure significantly increased（P<0.01）. Immediate after the PBPV, there are93%patients reach the upper goodlevel.In the mild，the moderate and the severe PS patients,their immediate PTGsafter PBPV are much lower than those before PBPV （P<0.01）. It is also notabledifference in these patients’ results （P<0.01）. The PTGs after the PBPV are obviouslower than those before when use different balloon/pulmonary valve annulus ratio（P<0.01）, however, there is no difference in these patients’ results （P<0.05）.Thefollow-up were performed from3months to14.75years.,after the PBPV thesymptoms obvious disappear in97.2%（171/176）,the murmurs were significantlyweakened and the thrill almost disappeared.Of the178patients with rightventricular hypertrophy before PBPV, normal electrocardiograms were observed in146（82%） patients, incomplete right bundle branch was observed in26（14.6%） andno significantly change in6（3.4%） after the procedure. The TTE showed that everyPTG after PBPV was obvious lower than that before PBPV （P <0.01）.Thesefollow-up PTGs were decreasing trend by the longer follow time.There are98.3% patients reach the upper good level in long-term follow-up time.The commoncomplications is right ventricular outflow obstruction，pulmonary regurgitation andtricuspid regurgitation.Four patients appeared severe complications, two cardiactamponade，one heart failure and hypoxicischemic encephalopathy，one chordalrupture of the tricuspid valve.We analysis these factors: sex, age, weight,cyanose ornot, V₁R,PS with ASD/PFO or not, PTG before PBPV, balloon/pulmonary valveannulus ratio, We found that only the degree of the stenosis is the strong negativeinfluencing factor of the immediate effect.Pre-procedure PTG is an important factorwhich leaded to the immediate PTG>25mmHg after PBPV.ConclusionBPPV as a treatment of PS is safe and reliable．It can effectively relievepulmonary stenosis．The immediate and media-long-term results are excellent andthe severe complications are few.It can be the first choice for the patients withcongenital PS.Pre-procedure PTG is an important influencing factor of the effect.