Long-term outcomes up to 25 years following balloon pulmonary valvuloplasty: A multicenter study.

OBJECTIVE: Evaluate long-term outcomes following balloon pulmonary valvuloplasty (BPV) for pulmonary stenosis (PS). BACKGROUND: Long-term data following BPV is limited to small, single center studies. METHODS: BPV from April 12, 1985 to January 7, 2015 from three centers were included. Outcomes studied were ≥ moderate PI by echocardiogram and residual PS ≥ 40 mm Hg. Risk factors for ≥ moderate PI, residual PS, and repeat intervention were assessed by univariate and multivariate analysis. RESULTS: Among 254 patients, mean age at BPV was 3.8 years (range 1 day-67 years), initial PS catheter gradient was 56 mm Hg (IQR 40-70), 19% had critical PS, and 9% had genetic syndromes. Mean follow-up duration was 7.5 years (maximum 25 years). Sixty-nine (29%) had ≥ moderate PI, 41 patients (17%) had residual PS > 40 mm Hg, and 31 (13%) had re-intervention. In univariate analysis, younger age, lower weight, greater initial PS gradient, greater initial RV/systemic pressure ratio, critical PS, and longer follow-up duration were associated with ≥ moderate PI. Greater initial PS gradient was associated with long-term residual PS or repeat intervention. In multivariate analysis, greater initial gradient and lower weight were independently associated with > moderate PI and greater initial PS gradient and genetic abnormality were independently associated with residual PS and repeat intervention. CONCLUSION: Smaller patients with greater initial PS were more likely to develop significant long-term PI. Patients with greater initial PS and genetic abnormalities were more likely to have residual PS or require repeat intervention following BPV.

White coat hypertension in childhood: evidence for end-organ effect.

OBJECTIVE: To evaluate the hypothesis that white coat hypertension (WCH) represents a prehypertensive state by correlating ambulatory blood pressure monitoring (ABPM) results with BP response to treadmill exercise (TE) and echocardiographic measurement of left ventricular mass index (LVMI) in children with high blood pressure (HBP). STUDY DESIGN: We evaluated 119 consecutive children age 6 to 18 years (mean = 13.3 years; 65% male) referred for HBP. Office systolic BP (SBP) exceeded the 95th percentile for age/sex/height in all of the children; 10% also had elevated diastolic BP (DBP). WCH was defined as elevated office SBP +/- elevated DBP with normal mean awake ABPM-SBP. ABPM classified 62 subjects as having WCH and 57 as having HBP. RESULTS: Office BP did not differ between the 2 groups. As defined, awake ABPM-SBP was lower in the WCH group (males: HBP, 142 +/- 12 vs WCH, 124 +/- 5; females: HBP, 137 +/- 8 vs WCH, 121 +/- 5). Awake and asleep DBP and asleep SBP were significantly lower in the WCH group. On TE, maximal SBP exceeded norms for age/sex/body surface area in 63% of the HBP group and 38% of the WCH group. LVMI exceeded the 95th percentile for age/sex in 59% of the males and 90% of the females in the HBP group and in 33% of the males and 36% of the females in the WCH group. CONCLUSIONS: Exaggerated exercise BP and/or increased LVMI in 62% of those subjects with WCH suggest that this diagnosis in children may represent a prehypertensive state.