Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-06-02T00:44:23.526Z Has data issue: false hasContentIssue false
  • English
  • Français

Configuration of right ventricular pressure curves and infundibular stenosis after balloon pulmonary valvoplasty

Published online by Cambridge University Press:  19 August 2008

Toshio Nakanishi ,
Tohru Tsuji ,
Makoto Nakazawa  and
Kazuo Momma
Toshio Nakanishi*
Affiliation:
From the Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo
Tohru Tsuji
Affiliation:
From the Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo
Makoto Nakazawa
Affiliation:
From the Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo
Kazuo Momma
Affiliation:
From the Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, Tokyo
*
Dr. Toshio Nakanishi, Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical College, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan
Get access Rights & Permissions [Opens in a new window]

Abstract

We evaluated the clinical significance of the configuration of right ventricular pressure curves after balloon valvoplasty in 35 patients with pulmonary valvar stenosis. Right ventricular pressures were measured with a fluidfilled catheter. We divided the subjects into two groups according to the pressure curves seen after balloon valvoplasty. In eight patients, two peaks were found in the curves, with the higher peak occurring at late systole. The remaining 27 patients had a single peak observed during early to mid systole. In all patients in the group with a single peak, the ratio of ventricular pressures decreased by more than half, and no residual narrowing was seen in right ventricular outflow tract, the diameter after valvoplasty increasing by more than half over the diameter before the procedure. In contrast, in five of eight patients in the group with double peaks in the pressure curves, the ratio between ventricular pressures remained higher than 0.5, and the diameter of the right ventricular infundibulum was reduced to less than half the diameter prior to balloon valvoplasty. In three of these patients with double peaked pressure contours, to whom propranolol was administered intravenously, the pressure configuration changed to one with a single peak and the ventricular pressure ratio fell to below 0.5. The degree of obstruction of the right ventricular infundibulum also decreased. These data suggest that a high right ventricular pressure and two peaks in the pressure curve with the higher peak at late systole after balloon valvoplasty indicate, first, the presence of a significant narrowing in the right ventricular outflow tract and, second, effective balloon valvoplasty.

Keywords

Pulmonary valvar stenosisballoon valvoplastyinfundibular stenosis
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 1 , January 1995 , pp. 44 - 47
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kan, JS, White, RI Jr, Mirchell, SE, Gardner, TJ.Percutaneous balloon valvuloplasty: A new method for treating congenital pulmonary valve stenosis. N Engl J Med 1982; 26: 540–542.Google Scholar
Keane, JF, Lock, JE. Catheter intervention: balloon valvotomy. In: Lock, JE, Keane, JF, Fellows, KE (eds). Diagnostic and Interventional Catheterization in Congenital Heart Disease. Martinus Nihoff Publishing, Boston, 1987, pp 111–121.CrossRefGoogle Scholar
Stanger, P, Cassidy, C, Girod, DA, Kan, JS, Lababidi, Z, Shapiro, SR.Balloon pulmonary valvuloplasty: Result of the valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 775–783.CrossRefGoogle ScholarPubMed
Rey, C, Marache, P, Francart, C, Dupuis, C.Percutaneous transluminal balloon valvuloplasty of congenital pulmonary valve stenosis, with a special report on infants and neonates. J Am Coll Cardiol 1988; 11: 815–820.Google Scholar
Radtke, W, Keane, JF, Fellows, KE, Lang, P, Lock, JE.Percutaneous balloon valvotomy of congenital pulumonary stenosis using oversized balloons. J Am Coll Cardiol 1986; 8:909–915.CrossRefGoogle Scholar
Robertson, M, Benson, LM, Smallhorn, JS, Musewe, N, Freedom, RM, Moes, CAF, Burrows, P, Johnston, AE, Burrows, FA, Rowe, RD.The morphology of the right ventricular outflow tract after percutaneous pulmonary valvotomy: Long-term follow-up. Br Heart J 1987; 58: 239–244.CrossRefGoogle ScholarPubMed
Rocchini, AP, Kveselis, DA, Crowley, D, Dick, M, Rosenthal, A.Percutaneous balloon valvuloplasty for treatment of congenital pulmonary valvular stenosis in children. J Am Coll Cardiol 1984; 3: 1005–1012.CrossRefGoogle ScholarPubMed
Shuck, JW, McCormick, DJ, Cohen, LS, Oetgen, WJ, Brinker, LA.Percutaneous balloon valvuloplasty of pulmonary valve: Role of right to left shunting through a patent foramen ovale. J Am Coll Cardiol 1984; 4: 132–135.CrossRefGoogle ScholarPubMed
Ben-Shachar, G, Cohen, MH, Sivakoff, MC, Portman, MA, Riemenschneider, TA, Van Heeckeren, DW.Development of infundibular obstruction after percutaneous pulmonary balloon valvuloplasty. J Am Coll Cardiol 1985; 5: 754–756.Google Scholar
Kasab, SS, Ribeiro, P, Zaibag, MA.Use of a double balloon technique for percutaneous balloon pulmonary valvotomy in adults. Br Heart J 1987; 58: 136–141.CrossRefGoogle ScholarPubMed
Engle, MA, Holswade, GR, Goldberg, HP, Lukas, DS, Glenn, F.Regression after open pulmonary valvotomy of infundibular stenosis accompanying severe valvular stenosis. Circulation 1958; 17: 862–873.CrossRefGoogle Scholar
Griffith, BP, Hardesty, RL, Siewers, RD, Lerberg, DB, Ferson, PF, Bahnson, HT.Pulmonary valvulectomy alone for pulmonary stenosis: results in children with and without muscular infundibular hypertrophy. J Thorac Cardiovasc Surg 1982; 83: 577–583.CrossRefGoogle Scholar
Moulaert, AJ, Buis-Liem, TN, Geldof, WC, Rohmer, J.The postvalvulotomy propranolol test to determine reversibility of the residual gradient in pulmonary stenosis.J Thorac Cardiovasc Surg 1976; 71: 865–868.CrossRefGoogle ScholarPubMed
Rao, PS, Fawzy, ME, Solymar, LMK.Long-term results of balloon pulmonary valvuloplasty of valvular pulmonic stenosis. Am Heart J 1988; 195: 1291–1296.CrossRefGoogle Scholar