The Cardiac Society of Australia and New Zealand

PULMONARY REGURGITATION AFTER PERCUTANEOUS BALLON VALVULOPLASTY IN ISOLATED PULMONARY VALVAR STENOSIS IN CHILDHOOD

KHL Poon*, S.Menahem, RG Weintraub, TH Goh, LV Fong, BD Edis, JL Wilkinson

Department of Cardiology, The Royal Children's Hospital, Melbourne.

Percutaneous balloon valvuloplasty is the recognized treatment of choice in pulmonary valvar stenosis. Previous studies have shown that surgical valvotomy may lead to significant pulmonary regurgitation. This study was to determine the degree of pulmonary regurgitation (PR), as assessed by echocardiography following balloon valvuloplasty in subjects with isolated pulmonary valvar stenosis. Fifty seven balloon valvuloplasties performed in 47 patients between December 1984 and August 1996 were retrospectively reviewed. Only those with at least 3 years' follow up were included. Six patients had 2 valvuloplasties, and one patient had 3 valvuloplasties. These were analysed separately. Their clinical records and investigations including their echocardiograms were reviewed.

Change in grade of PR^a	Number of patients	Balloon size/ annulus ratio^b	Age at time of valvuloplasty^b (yrs)	Duration of follow-up^b (yrs)
0	1	0.9	11.4	3.2
1	11	1.25(0.9-2.14)	2.28(0.0-13.3)	7.7(3.2-11.0)
2	14	1.4(1.0-1.8)	1.2(0.0-7.0)	4.6(3.0-12.4)
3	14	1.3(0.7-1.7)	1.4(0.0-6.0)	6.2(1.8-14.3)
4	2	1.3(1.2-1.4)	0.5(0.5-0.5)	10.0(8.9-11.0)
Table 1 : Outcome of subjects following single valvuloplasty ^a Following valvuloplasty ^bAll figures quoted as median with range in brackets.

Patients with congenital isolated pulmonary valvar stenosis who required balloon valvuloplasty early in life were more likely to develop significant PR. The higher the initial grade of PR, the more likely it was to progress with time. The balloon size to annulus ratio did not significantly alter the outcome.The majority of the patients had only a mild increase in the degree of PR after single valvuloplasty. Six out of the 7 patients who had more than one valvuloplasty were less than 6 months at the time of the first valvuloplasty. Three of these had grade 3 pulmonary regurgitation at latest follow-up.

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