Browsing by Author "KUMAR, A"

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    BALLOON PULMONARY VALVOPLASTY - FACTORS DETERMINING SHORT-TERM AND LONG-TERM RESULTS
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 1993)
    Balloon pulmonary valvoplasty was performed in 139 patients (age 2-44 years) with pulmonary valve stenosis. The right ventricular peak systolic pressure decreased from 137.1 +/- 46.8 mmHg to 76 +/- 51.3 mmHg (P < 0.001) and the right ventricle to pulmonary artery peak systolic gradient decreased from 116.3 +/- 49 mmHg to 54.4 +/- 51.9 mmHg (P < 0.001). There was no significant change in systemic artery systolic pressure. The right ventricular peak systolic pressure to systemic artery systolic pressure ratio decreased from 1.13 +/- 0.41 to 0.63 +/- 0.42 (P < 0.001). Patients with incomplete immediate relief of obstruction (right ventricle to pulmonary artery peak systolic gradient > 35 mmHg) had higher pre-dilatation right ventricular peak systolic pressure (161.1 +/- 45.3 mmHg vs. 93.9 +/- 38.8 mmHg, P < 0.001) and higher right ventricular peak systolic pressure to systemic artery systolic pressure ratio (1.31 +/- 0.42 vs 0.98 +/- 0.33, P < 0.001) pre-dilatation and were older (17.2 +/- 8.6 years vs. 12.8 +/- 9.7 years, P < 0.01). The residual right ventricle to pulmonary artery peak systolic gradients in the majority of patients were infundibular, which regressed at follow up even in patients who did not receive long-term oral beta blockers. Follow up catheterisation in 79 patients after 13 +/- 8.7 months showed a further fall in right ventricular peak systolic-pressure (P < 0.001) and right ventricle-to-pulmonary artery peak systolic gradient (P < 0.001). As assessed by follow up catheterisation data, 81% had no significant residual right ventricle-to-pulmonary artery peak systolic gradient while four patients showed significant increase in gradients compared to values obtained immediately after balloon pulmonary valvoplasty. A higher postdilatation right ventricular peak systolic pressure to systemic artery systolic pressure ratio was predictive of an unsatisfactory late result. Among patients with a dysplastic pulmonary valve only those with a mild degree of dysplasia improved. In conclusion balloon pulmonary valvoplasty is safe and provides long-term relief of obstruction in the majority of patients with pulmonary valve stenosis. Older patients with more severe stenosis are more likely to have residual infundibular gradients. Infundibular gradients regress at followup with or without beta blockers.