Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children

Claire Peterson, Johanneke J. Schilthuis, Ali Dodge-Khatami, J. Francois Hitchcock, Erik J. Meijboom, Ger B W E Bennink, John Brown, Muhammad A. Mumtaz, Gerhard Ziemer, John E. Mayer

Research output: Contribution to journalArticle

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Abstract

Background. We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for pulmonary valve stenosis in infants and children. Methods. Results after surgical pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 ± 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 ± 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, pulmonary valve insufficiency, and tricuspid valve insufficiency were considered. Results. Mean pressure gradient decreased significantly more in the surgical group (from 64.8 ± 30.8 mm Hg to 12.8 ± 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 ± 21.4 mm Hg to 21.5 ± 15.9 mm Hg after a mean of 5.4 years; p <0.001). Moderate pulmonary valve insufficiency occurred in 44% after surgery, and in 11% after BV (p <0.001). Tricuspid valve insufficiency occurred in 2% after surgery, and in 5% after BV. Restenosis occurred in 3 surgical patients (5.6%), 2 patients required reoperation, and 1 patient required a balloon valvotomy. Restenosis developed in 13 BV patients (14.1%): 6 patients were redilated and 7 patients required surgery. Surgical valvotomy led to significantly less reinterventions than balloon valvuloplasty (p <0.04). Conclusions. Surgical relief of pulmonary valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated pulmonary valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed.

Original languageEnglish (US)
Pages (from-to)1078-1083
Number of pages6
JournalAnnals of Thoracic Surgery
Volume76
Issue number4
DOIs
StatePublished - Oct 1 2003
Externally publishedYes

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Balloon Valvuloplasty
Pulmonary Valve Stenosis
Pulmonary Valve Insufficiency
Tricuspid Valve Insufficiency
Pressure
Reoperation
Length of Stay
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Peterson, C., Schilthuis, J. J., Dodge-Khatami, A., Hitchcock, J. F., Meijboom, E. J., Bennink, G. B. W. E., ... Mayer, J. E. (2003). Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children. Annals of Thoracic Surgery, 76(4), 1078-1083. https://doi.org/10.1016/S0003-4975(03)00678-7

Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children. / Peterson, Claire; Schilthuis, Johanneke J.; Dodge-Khatami, Ali; Hitchcock, J. Francois; Meijboom, Erik J.; Bennink, Ger B W E; Brown, John; Mumtaz, Muhammad A.; Ziemer, Gerhard; Mayer, John E.

In: Annals of Thoracic Surgery, Vol. 76, No. 4, 01.10.2003, p. 1078-1083.

Research output: Contribution to journalArticle

Peterson, C, Schilthuis, JJ, Dodge-Khatami, A, Hitchcock, JF, Meijboom, EJ, Bennink, GBWE, Brown, J, Mumtaz, MA, Ziemer, G & Mayer, JE 2003, 'Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children', Annals of Thoracic Surgery, vol. 76, no. 4, pp. 1078-1083. https://doi.org/10.1016/S0003-4975(03)00678-7
Peterson, Claire ; Schilthuis, Johanneke J. ; Dodge-Khatami, Ali ; Hitchcock, J. Francois ; Meijboom, Erik J. ; Bennink, Ger B W E ; Brown, John ; Mumtaz, Muhammad A. ; Ziemer, Gerhard ; Mayer, John E. / Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children. In: Annals of Thoracic Surgery. 2003 ; Vol. 76, No. 4. pp. 1078-1083.
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abstract = "Background. We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for pulmonary valve stenosis in infants and children. Methods. Results after surgical pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 ± 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 ± 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, pulmonary valve insufficiency, and tricuspid valve insufficiency were considered. Results. Mean pressure gradient decreased significantly more in the surgical group (from 64.8 ± 30.8 mm Hg to 12.8 ± 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 ± 21.4 mm Hg to 21.5 ± 15.9 mm Hg after a mean of 5.4 years; p <0.001). Moderate pulmonary valve insufficiency occurred in 44{\%} after surgery, and in 11{\%} after BV (p <0.001). Tricuspid valve insufficiency occurred in 2{\%} after surgery, and in 5{\%} after BV. Restenosis occurred in 3 surgical patients (5.6{\%}), 2 patients required reoperation, and 1 patient required a balloon valvotomy. Restenosis developed in 13 BV patients (14.1{\%}): 6 patients were redilated and 7 patients required surgery. Surgical valvotomy led to significantly less reinterventions than balloon valvuloplasty (p <0.04). Conclusions. Surgical relief of pulmonary valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated pulmonary valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed.",
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AU - Dodge-Khatami, Ali

AU - Hitchcock, J. Francois

AU - Meijboom, Erik J.

AU - Bennink, Ger B W E

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