Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects

Pulmonary stenosis (PS) is mainly a congenital defect that accounts for 7-12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25-30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS.

Interventional Treatment of Pulmonary Valve Stenosis: A Single Center Experience

BACKGROUND

Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis.

AIM

The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate.

MATERIAL AND METHODS

The study included 43 patients, where 33 (74%) of them were children between the age of 1 month and 15 years.

RESULTS

The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg) to 39.1 mmHg (20-80 mmHg). Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9%) required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55%) patients, and four (9%) patients developed moderate regurgitation, without affecting the function of the right ventricle.

CONCLUSIONS

Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results.

Percutaneous pulmonary valve implantation: fixing the problems and pushing the envelope

PURPOSE OF REVIEW

A recent development within pediatric cardiology is percutaneous pulmonary valve implantation (PPVI). This has extended the life of surgical conduits and decreased the number of surgical procedures required. Early reports focused on feasibility and safety of the technique; recent literature has focused on avoidance of complications such as stent fractures and on expanding the procedure to nonconduit implantation. The purpose of this review is to summarize the recent data regarding stent fractures and alternative uses of the valve.

RECENT FINDINGS

Stent fractures following PPVI are reported in 20-28% of patients. Prestenting has recently been shown to be protective and to extend the freedom from stent fractures. The use of PPVI has also been reported in nonconduit positions such as in bioprosthetic tricuspid valves, branch pulmonary arteries, aortic and mitral positions. In addition, the valve has been implanted in higher pressure environments. The short-term success in these applications appears to be quite good.

SUMMARY

PPVI has allowed extension of the life of surgical conduits and failure of the valve is mainly related to stent fractures. Recent developments have minimized this complication. In addition, use of the valve has been extended to nontraditional locations and short-term results are favorable.