Percutaneous transluminal valvuloplasty in pulmonary stenosis: A series of 35 cases

Thirty-five patients with moderate or severe valvular pulmonary stenosis underwent percutaneous transluminal valvuloplasty (PTV). The average age of the patients was 12 years (range 4 to 34 years). Sixty percent were under the age of 10, 20 p. 100 were between 10 and 17 years old and 20 p. 100 between 18 and 34 years old. Systolic right ventricular pressures were greater than the pressures in the systemic circulation in 22 cases. The right ventricular-pulmonary artery pressure gradient was greater than 50 mmHg in 29 patients and less than or equal to 50 mmHg in the other 6 patients. The diameter of the balloon of the dilation catheter varied from 12 to 20 mm in 31 PTV; in the other 4 cases two dilating catheters were used simultaneously to dilate the pulmonary valves. The tolerance of PTV was generally good and the results were satisfactory: right ventricular pressures (RVP) fell from 140 ± 45 to 77 ± 25 mmHg (p < 0.001); the RV-PA pressure gradient fell from 82 ± 40 to 32.4 ± 15 mmHg (p < 0.001) and the ratio of RVP to systemic pressure from 1.2 ± 0.4 to 0.65 ± 0.2 (p < 0.01). Clinical and haemodynamic reevaluation in 19 patients 4 to 16 months after PTV (mean 8.5 ± 2 months) showed that RVP, RV-PA pressure gradients and RVP/systemic pressure ratios had significantly decreased respectively from 78 ± 30 to 52 ± 14 mmHg (p < 0.001), from 27.7 ± 7.7 to 21.8 ± 7.3 mmHg (p < 0.02) and from 0.6 ± 0.2 to 0.4 ± 0.1 (p < 0.001). Pulmonary valvuloplasty is well tolerated, safe and may reduce the number of patients requiring surgical valvotomy.