Percutaneous balloon pulmonary valvuloplasty in children: a 10-Year retrospective follow-up study in resource-limited settings.

BACKGROUND

Percutaneous balloon pulmonary valvuloplasty (BPV) is the preferred treatment for pulmonary valve stenosis owing to its effectiveness and safety in patients with appropriate valves. However, there is a lack of research on the immediate and midterm results in developing nations. Thus, this study aimed to evaluate the immediate and midterm outcomes of patients who underwent BPV at the Cardiac Center of Ethiopia.

METHODOLOGY

A follow-up study was conducted from April 2023 to August 2023 using retrospective chart reviews and phone interviews involving 138 patients aged ≤ 18 years who underwent balloon BPV for moderate to severe pulmonary stenosis (defined as peak pulmonary valvular gradient ≥ 50 mmHg) at the Cardiac Center of Ethiopia between January 2012 and March 2023. The study's primary objective was to assess the procedure's immediate success and mid-term outcomes. The study employed various statistical tests, including a multivariable logistic regression model, to identify predictors of the development of moderate to severe pulmonary regurgitation and restenosis.

RESULTS

The patients' median age was 3.95 years (1.5-13 years), with a female to male ratio 1.6. Following BPV, there was a significant decrease in the median peak pulmonary trans-valvular gradient from 106 mmHg to 40 mmHg (p < 0.001). The immediate success rate was 71%, with post-procedural complications at 4.3%. In a median follow-up of 114 months (IQR 72-132 months), 34.1% developed moderate to severe PR, and restenosis occurred in 24.4%. High balloon annulus ratio predicted moderate to severe PR, while dysplastic or complex pulmonary valve, high pre-procedural and immediate post-procedural peak gradients, and high pre-procedural left ventricular systolic pressure predicted restenosis.

CONCLUSION

Most patients typically achieve initial success following BPV at our center. However, it is not unusual for moderate to severe pulmonary regurgitation and restenosis to develop during follow-up. As such, this study underscores the significance of thorough follow-up care for patients who underwent BPV to promptly detect and address potential complications.