ABSTRACT
Balloon pulmonary valvuloplasty is the treatment of choice for moderate to severe pulmonary stenosis in children. Abnormalities of valve-annulus-trunk structure could possibly determine the outcome after balloon valvuloplasty. The purpose of our study is to show the value of echocardiography In the prediction of the outcome of balloon valvuloplasty in children with pulmonary valve stenosis 104 patients [58 females and 46 males], their age ranged between 1-14 years with a mean of 6.49 +/- 4.4 years were included in our study. All patients had valvular pulmonary stenosis with pressure gradient across the pulmonary valve > 50 mmHg. All cases were subjected to balloon valvuloplasty, The morphologic features of pulmonary valve-annulustrunk structure were quantified by echocardiography and scored as follow a-Valve mobility 0, 1 or 2, b-Valve thickness 0,l or 2. c-Post stenotic narrowing 0,1 or 2. d-Post-stenotic dilatation 0 or 1 e-Diastolic deformity of sinus of valsalva 0 or 1, The total echocardiographic score ranged between 0 and 8. Balloon valvuloplasty was performed one day after echocardiographic examination. The follow up of our cases was done one day and 6 months after valvuloplasty by continuos wave Doppler for estimation of pressure gradient across the pulmonary valve. The studied cases were classified into two groups : Group I, when the gradient across the pulmonary valve immediately after valvuloplasty was 35 mmHg [successful] and group II, when the gradient was > 35 mmHg [unsuccessful]. There was a significant decrease in the transpulmonary valvular gradient [from 90.19 +/- 28.37 to 31.65 +/- 21.56 mmHg] with further reduction of gradient at follow up study after 6 months [to 26.65 +/- 11.92 mmHg]. The echocardiographic scoring of pulmonary valve was higher in group II [6.21 +/- 1.37] than in group I [2.7 +/- 1.29]. Patients with score less than two showed optimal results. Those with score more than four had a poor outcome, while very poor outcome was observed in patients with score more than six. The echocardiographic scoring can predict the outcome of balloon pulmonary valvuloplasty in children with pulmonary valve stenosis
Subject(s)
Humans , Male , Female , Echocardiography , Postoperative Complications , Treatment Outcome , Postoperative Care , Pulmonary Surgical Procedures , ChildABSTRACT
Pulmonary artery pressure [PAP] was estimated by both catheter and Doppler techniques in 23 patients with pulmonary hypertension. All patients had tricuspid and pulmonary regurgitation. Utilizing different methods for estimating [PAP], the pulmonary regurgitant flow velocity method was used to estimate mean [PAP] and diastolic [PAP]. A good correlation was found between this method and cardiac catheter, p< 0.01, the sensitivity was 90% and specificity was 95%. Tricuspid regurgitant flow velocity method for estimation of systolic [PAP] showed high accuracy with systolic [PAP] determined by catheterization, p < 0.01 and sensitivity was 92% and specificity was 95%. Using time peak velocity of pulmonary flow [AT] to measure mean [PAP], there was a tendency for over estimation in patients with [AT] 80 msec., On the other hand patients with [AT] < 80 msec. showed 80% sensitivity and a 98% specificity for detection of elevated [PAP]. So peak tricuspid velocities provided unexpectedly difficult record in some patients but when successful, it provides excellent prediction of pressures. Recording of mean [PAP] from [AT] of pulmonary artery wave form was very easy but accuracy was limited was limited to whom [PAP] was high. In contrast, pulmonary regurgitation velocities were easily obtained and provided high accuracy results