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Percutaneous transluminal pulmonary valvuloplasty for severe to critical valvular pulmonary stenosis in neonates and infants.

The aim of this study was to report the experience of percutaneous transluminal pulmonary valvuloplasty (PTPV) in neonates and infants with severe to critical valvular pulmonary stenosis. From May 1997 to May 2002, a total of 7 consecutive patients, aged 2 days to 6 months, with severe to critical valvular pulmonary stenosis were enrolled in this retrospective study. Patients having pulmonary atresia with intact interventricular septum, and pulmonary stenosis complicated with other cardiac malformations were excluded from this study. We performed PTPV in all 7 patients by using a single balloon catheter, with a diameter 20% to 40% larger than that of the pulmonary annulus. The pressure gradients across the pulmonary valve ranged from 80 to 96 mmHg (mean 85.0+/-5.4) by Doppler echocardiography, and ranged from 80 to 119 mmHg (mean 92.3+/-14.2) by pullback pressure tracings at cardiac catheterization before PTPV. After PTPV, the pressure gradients ranged from 13 to 40 mmHg (mean 24.9+/-10.1) by immediate pullback pressure tracings (p <0.05), and ranged from 15 to 28 mmHg (mean 20.6+/-5.3) by Doppler echocardiography within 24 hrs (p<0.05). The ratio of systolic pressure of the right ventricle to that of the left ventricle (sRV/sLV) ranged from 1.0 to 1.6 (mean 1.2+/-0.2) before PTPV, and ranged from 0.4 to 0.7 (mean 0.5+/-0.1) after PTPV (p<0.05). At follow-up 3 months after PTPV, the Doppler echocardiographic pressure gradients ranged from 14 to 27 mmHg (mean 19.3+/-5.3). We conclude that PTPV can attain an excellent success rate in infants and neonates with severe to critical valvular pulmonary stenosis without sequelae.