ABSTRACT
Clinical data of 23 children with atrial septal defect and pulmonary valvular stenosis admitted in Dalian Children′s Hospital during March 2015 to March 2018 were retrospectively analyzed. Twenty patients were treated with percutaneous closure of atrial septal defect through femoral vein first, then transthoracic echocardiography-guided balloon pulmonary valvuloplasty was performed; while 3 patients had no balloon pulmonary valvuloplasty after percutaneous closure of atrial septal defect. Patients were followed up by transthoracic echocardiography and all were doing well. The transvalvular pressure fell under 35 mmHg (1 mmHg=0.133 kPa) [(19.5±1.9)mmHg] in all patients, which was significantly lower than that before treatment [(62.0±7.8 mmHg)] (t=28.92, P<0.01). During follow-up, no residual shunt of atrial septal defect was found; and mild pulmonary regurgitation occurred in 3 cases. The study indicates that combined percutaneous treatment with transthoracic echocardiography guidance is effective and safe for children with atrial septal defect and pulmonary valvular stenosis. The pulmonary artery stenosis of some patients can be alleviated, after closuring of the atrial septal defect.
ABSTRACT
PURPOSE: Balloon valvuloplasty(BVP) is the treatment of choice for valvular pulmonary stenosis (PS). However, this procedure was usually performed in children older than 2 years. The purpose of the present study was to assess the safety and efficacy of BVP in young infants. METHODS: Retrospective analysis of the medical records of 25 infants younger than 6 months of age who received BVP for PS including critical PS between July 1991 and September 1997 were evaluated. RESULTS: The arterial oxygen saturation before and after procedure was 76.7% and 90.0%, respectively(P<0.001). Transvalvar pressure gradients measured with continuous wave Doppler echocardiography changed from 103.2+/-27.1mmHg to 34.8+/-14.4mmHg(P<0.001) and 29.3+/-15.9 mmHg after 6 months(P=0.075). The systolic pressure ratio of right and left ventricle before and after procedure was decreased from 1.40+/-0.4 to 0.74+/-0.3(P<0.001). Successful gradient relief was achieved with initial BVP in 21 out of 25 infants. There was one procedural death and one emergency surgery after BVP. Four of the 23 remaining patients required repeated BVP. CONCLUSION: Balloon valvuloplasty in young infants is a safe and effective procedure. In patients with symptomatic severe PS, balloon valvuloplasty should be recommended at an early age.