Evaluation of the middle and long term results of patients with valvuloplasty caused by valvular pulmonary stenosis

Background and Aim: Isolated pulmonary stenosis (PS) is one of the most common congenital heart diseases. Surgical procedures has been replaced with balloon pulmonary valvuloplasty (BPV) which has low complication rate, ease of operation and successful early and long term results in terms of correction of PS. The aim of this study was to evaluate the efficacy and long-term results of BPV in patients with valvular pulmonary stenosis. Materials and Methods: Patients who underwent pediatric disease services between the dates of January 1, 1992 to January 1, 2017 from the Hospital Information System of Dokuz Eylül University Medical Faculty Hospital were enrolled. Patients, underwent BPV ageing between 0 day-18 years and diagnosed as having moderate to severe pulmonary stenosis in their ECO examination included in the study group. Patients' epicrisis and outpatient admissions were evaluated retrospectively. Demographic data of the patients, laboratory and imaging examinations, treatments and hospital stay were recorded in case report form. Relationship between balloon length and tricuspid regurgitaion, and relationship between ballon diameter and pulmonary regurgitation were investigated Findings: In our study, 153 patients who underwent BPV due to moderate and severe PS were examined. In the study, 50.3% (n=77) were female and 49.7% (n=76) were male. In 127 patients, the mean right ventricular pressure (RVP) value was 80 ± 26 mmHg (65-105 mmHg) before BPV and this value was found to be 45 ± 14 mmHg (35-57 mmHg) after BPV. In 107 patients, the mean PAPs measured before BPV was 18 ± 6,2 mmHg (15-20 mmHg) and this value was 22 ± 6 mmHg (17-25 mmHg) after BPV. In 111 patients, the mean PAPm value before BPV was 12 ± 4,5 mmHg (10-15 mmHg) and this value was found to be 15 ± 5 mmHg (10-16 mmHg) after BPV. When the RVP and PAP values were compared before and after BVP, there was a significant difference in the severity of the disease (p <0.001). The mean RV-PA pressure gradient measured before BPV was 78,75 ± 22,15 mmHg in the evaluation of 72 patients with complete data on RV-PA pressure gradient measurements. The mean RV-PA pressure gradient measured on the first day after BPV was 42,12 ± 21,3 mmHg PA pressure gradient average 37.89 ±21,1 mmHg and the last RV-PA pressure gradient measured after 12 months has been found to be 31.99 ± 23,9 mmHg and the severity of the disease was significantly decreased over time. The mean anulus diameter of 140 patients was 12.78 ± 4,3 cm. There was no statistically significant difference between relationship of pulmonary regurgitation scores after BVP and balloon diameter/annulus diameter in 132 patients. It was found that the balloon height / annulus diameter ratio was related to the degree of tricuspid regurgitaion. On the other hand, if this rate was over 0.27, moderate and severe tricuspid regurgitaion levels were found to be significantly higher (p <0.05). Conclusion: In our study, it was found that BVP was effective treatment for moderate and severe pulmonary stenosis because of its low complication rate and high treatment success. There was a correlation between balloon length and balloon induced tricuspid failure was observed during BPV. Therefore, it is decided that the balloon length used is as important as its diameter