Abstract

ABSTRACT:
BACKGROUND:
Balloon pulmonary valvuloplasty (BPV) represents the standard of management for all patients with severe pulmonary valve stenosis (PS) irrespective of their age. Nevertheless , neonates and infants with critical PS represent an emergency and a high risk group that needs to be studied.
OBJECTIVE:
To evaluate results ,complications and follow up of BPV in neonates and infants with critical PS.
PATIENTS AND METHODS:
During the period extending from February 2010 to February 2011, 25 neonates and infant patients with critical PS were subjected to detailed history taking, full clinical examination, resting 12-lead ECG, chest x-ray and transthorasic echocardiography.BPV was attempted in all patients .Full echocardiographic evaluation was done 24 hour after the procedure as well as 3 and 6 months later.
RESULTS:
Twenty five patients with critical PS with a mean age of 32.7 ± 21.9 days were subjected to BPV .Immediately after the procedure , patients had a significant reduction of the right ventricular systolic pressure (RVSP) from a mean of 103.96 ± 24.98 mmHg to a mean of 43.6 ± 13 mmHg . The immediate success rate(defined as the drop in the RVSP to less than or equal to 50% of the baseline measurement) was achieved in 76% of cases . Throughout a follow up period of six months, there was a progressive decline in the pressure gradient (PG) across the PV by Doppler echocardiogram from a mean of 93.3 ± 18.2 mmHg to a mean of 17.4 ± 10.42 mmHg. The oxygen saturation increased from 80 ± 8% to 96 ± 2% . There was a significant increase in the mean PV annulus diameter after balloon dilatation from a mean value of 7.1 ± 1.9 mm to a mean value of 9.3 ± 1.1 mm. The incidence of pulmonary incompetence (PI) significantly increased immediately after BPV to 66.6% followed by a progressive decline over a 6 months period of follow up to 19% . Over the same period of follow up , there was a significant decrease in the incidence of tricuspid regurgitation (TR) from 32% to 9.5% . There were complications including three deaths (12%).One patient was referred to surgery (4%) and two had developed significant re stenosis (8%) .
CONCLUSION:
BPV is safe and effective procedure to relieve critical PS in neonates and infants that should be done as early as possible .