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5 results

  • Results of balloon pulmonary valvoplasty in children with Noonan’s syndrome

  • Jonathon Holzmann, Shane M. Tibby, Eric Rosenthal, Shakeel Qureshi, Gareth Morgan, Thomas Krasemann
  • Journal:
    Cardiology in the Young / Volume 28 / Issue 5 / May 2018
    Published online by Cambridge University Press:
    10 January 2018, pp. 647-652

  • Pulmonary valve stenosis is common in patients with Noonan’s syndrome. The response to balloon valvoplasty varies.

    We assessed the correlation between re-intervention rate, immediate response, and the progress of the valve gradient over time after intervention.

    Methods

    This is a retrospective study conducted from 1995 to 2014.

    Results

    Of 14 patients identified, seven had re-intervention 28±54 months (range 3–149, median 3.3) after valvoplasty. These patients did not have a significant decrease in gradient after intervention. Their gradient subsequently decreased during follow-up and then became static before increasing years after intervention. In contrast, the gradient of patients not requiring further intervention continually reduced over time. Demographics did not differ between these groups.

    Conclusion

    We could not identify predisposing factors for long-term success of pulmonary valvoplasty in Noonan’s patients, but the trajectory of gradients differs significantly between patients needing re-intervention from those who remain free from re-intervention.

  • Balloon valvoplasty in infants with tetralogy of Fallot: effects on oxygen saturation and growth of the pulmonary arteries

  • A. Heusch, A. Tannous, O. N. Krogmann, M. Bourgeois
  • Journal:
    Cardiology in the Young / Volume 9 / Issue 1 / January 1999
    Published online by Cambridge University Press:
    19 August 2008, pp. 17-23

  • Balloon valvoplasty was undertaken in 27 patients with tetralogy of Fallot for first-stage palli-ation. Indications were arterial saturation of oxygen <80%, hypoxic spells and duct-dependant pulmonary perfusion. The dilation was performed following diagnostic heart catheterization. Saturations improved from 75% ± 8.5 before valvoplasty to 85% ± 8.4 after the procedure, and worsened little to 83% ± 9.6 at follow-up after 3.4 months. The pulmonary valvar orifice was hypoplastic in most patients (Z = — 3.3 ± 1.2), and did not change after the procedure. The cross-sectional area of the pulmonary arteries was diminished initially, reflected by a Nakata index of 186 ± 95 mm2/rn2. After valvoplasty, we found widening of the vessels (Nakata index 225 ± 100 mm2/m2). At follow-up no further growth of the arteries was observed (Nakata index 209 ±109 mm2/m2). The procedure was complicated by hypoxic spells in three patients which were controlled by intravenous propranolol, and deep venous thrombosis in four patients. Our data demonstrate that balloon valvoplasty is feasible for initial palliation in patients with tetralogy of Fallot. It does not, however, produce growth of the pulmonary arteries or of the pulmonary valve.

  • Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry

  • Blair V. Robinson, Grazyna Brzezinska-Rajszys, Howard S. Weber, Joanna Ksiazyk, F. Jay Fricker, Donald R. Fischer, José A. Ettedgui
  • Journal:
    Cardiology in the Young / Volume 10 / Issue 3 / May 2000
    Published online by Cambridge University Press:
    19 August 2008, pp. 225-232
  • Objectives

    The purpose of this study was to evaluate the short and intermediate term results of infants who have undergone balloon aortic valvotomy from the carotid arterial approach, and to identify risk factors in those infants who had a poor outcome.

    Methods

    Between 1988 and 1999, balloon aortic valvotomy was attempted at four centres in 95 infants with severe aortic stenosis. Echocardiographic and hemodynamic data, and outcome, were analysed retrospectively.

    Results

    Valvotomy was accomplished in 92 of the 95 infants, with a median age of 5 days, a range from 0 to 191 days, and weighing 3.4 kg, with a range from 1.0 to 6.5 kg. Major procedural complications occurred in 10 infants. Post-procedural aortic regurgitation was severe in 5 patients. There were 13 early deaths, and 4 late deaths. The period of mean follow-up has been 2.1 years, with a range from 0 to 9.3 years. The actuarial survival at 3 years was 76 ± 6%. Further interventions were needed in 19 patients, giving a 3-year freedom from reintervention of 67 ± 6%. The 51 infants who were duct-dependent were further analyzed, and found to have a higher mortality (38%) compared to those infants not dependent on the arterial duct (5%). Risk factors for a poor outcome in the duct-dependent infants were mitral stenosis (p<0.005), a left ventricle which did not form the cardiac apex (p<0.005), and an aortic valve with a diameter of less than 6 mm (p<0.05).

    Conclusions

    This multi-centric registry shows good results in the intermediate term for treating infants with severe aortic valvar stenosis with balloon valvotomy through a carotid arterial cutdown. Infants dependent on prostaglandin had a worse outcome, especially if they had any of the identified risk factors.