INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

PERCUTANEOUS BALLOON PULMONARY VALVULOPLASTY

Pelin Aladağ

Zonguldak Bülent Ecevit University, Faculty of Medicine, Department of Cardiology, Zonguldak, Türkiye

Aladağ P. Percutaneous Balloon Pulmonary Valvuloplasty. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.369-376.

ABSTRACT

Balloon pulmonary valvuloplasty is a minimally invasive procedure performed in newborns, children and adults to relieve pulmonary valve stenosis and improve symptoms. It is generally indicated for patients with moderate/severe pulmonary stenosis (PS) with peak-to-peak gradients greater than 50 mm Hg.. Balloon valvuloplasty is the first-choice treatment option for patients with valvular PS if the valve structure is favourable. This technique includes the insertion of one or more balloon catheters, usually advanced over an extra-stiff guidewire, into the pulmonary valve and inflation of the balloon(s). Thus, pulmonary valve dilatation is achieved. In the light of recent literature, the recommendation is a balloon-to-annulus ratio of 1.2:1.25.

Following successful balloon dilatation, a decrease in gradient to <30 mm Hg, an improvement in jet width and free movement of the pulmonary valve cusps with fewer doming, improvement in right ventricular function and tricuspid regurgitation should be observed. Complications may occur, but major complications and death are rare. However, restenosis, defined as a gradient greater than 50 mm Hg, was observed in approximately 10 per cent of patients. Recovery after balloon dilatation in adults is better in the long term. Predictors of restenosis involve a balloon/annulus ratio <1.2 and an instantaneous gradient greater than 30 mm Hg after valvuloplasty. Many patients (40-90%) experience post-procedural pulmonary regurgitation, which does not need surgical operation in most patients. The 10-year long-term follow-up results show that approximately 80-90% of patients have substantial improvement of the pulmonary valve and do not require reintervention.

In conclusion, balloon pulmonary valvuloplasty seems as the first-line treatment option for adult pulmonary valve stenosis. Percutaneous balloon pulmonary valvuloplasty (PBPV) is the gold standard for the treatment of patients with pulmonary valve stenosis in children and adults.

Keywords: Pulmonary valve stenosis; Percutaneous balloon pulmonary valvuloplasty; Outcome of follow-up; Restenosis; Pulmonary regurgitation

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