Balloon angioplasty in the treatment of pulmonary valve stenosis and coarctation of the aorta.

When balloon angioplasty of the pulmonary valve was attempted in 42 children, aged 1 day to 19 years (mean, 3.1 years), immediate relief of pulmonary stenosis was achieved in 37 cases. In two groups, angioplasty was not uniformly successful: these included (1) two neonates and (2) three out of seven children with dysplastic pulmonary valves, who had an unsuccessful early result. Long-term (>1-year) follow-up of 28 successful cases supports the contention that balloon angioplasty provides effective long-term relief of pulmonary valve stenosis and that it should be considered the treatment of choice for this lesion. The results of angioplasty were also studied in 36 children who underwent this procedure to treat coarctation of the aorta (involving 21 native and 15 recurrent lesions). Angioplasty effectively relieved the obstruction in 30 cases (17 native and 13 recurrent lesions). In the six unsuccessful cases, poor hemodynamic results were due to age (three failures occurred in children less than 2 years old), tubular hypoplasia of the aorta (in one case), and the use of an undersized angioplasty balloon (in four cases, the diameter of the balloon was > or =3 mm less than that of the aortic isthmus). The 36 patients had two major complications: A cerebral vascular accident occurred in one case, and a late aortic aneurysm developed in another. Our results indicate that angioplasty is an effective form of therapy for most cases of coarctation of the aorta (whether native or recurrent).