Critical Pulmonary Stenosis in Infants and Neonates in the Era of Interventional Cardiology

Abstract

Between September 1992 and February 1998, 22 consecutive patients aged 4 to 90 days with critical valvular pulmonary stenosis underwent percutaneous transluminal balloon valvuloplasty. Sixteen were cyanosed and 7 required prostaglandin infusion. The pulmonary valve was successfully crossed in all patients. Progressive dilatation was used to attain a final balloon to valve ratio between 1.2 and 1.4. Mean right ventricular systolic pressure dropped from 109 ± 26 to 34 ± 1 mm Hg. Oxygen saturation increased from 84% ± 8% to 98% ± 2%. There were 5 complications including 1 death due to valvular damage, 1 hemopericardium requiring drainage and transfusion, significant blood loss during cannulation in 2 cases, and a fractured guidewire that was retrieved in another. Repeat valvuloplasty was performed in 2 patients. Two patients required surgery; one had a dysplastic pulmonary valve with persistent pulmonary stenosis and the other had a hypoplastic right ventricle. Of the 20 patients who had valvuloplasty alone, 17 (85%) remained well with a mean peak systolic Doppler gradient of 30 ± 26 mm Hg and no pulmonary regurgitation. We concluded that valvuloplasty is likely to be the only procedure necessary for the majority of infants and neonates with critical pulmonary stenosis. However, surgery is required in cases of dysplastic pulmonary valve or hypoplastic right ventricle.