الفهرس 
Pulmonary stenosisOnly 14 pages are availabe for public view
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Abstract
P
ulmonary stenosis is the second most common congenital cardiac malformation. Surgical valvotomy was the traditional method of treatment for congenital pulmonary valve stenosis until the technique of BPV was introduced initially by Kan et al. in 1982.
The purpose of this study was to determine the independent factors that impact on the long-term outcome and clinical course of pulmonary stenosis after BPV.
The study included 70 patients with moderate or severe pulmonary stenosis who were referred for follow up echocardiography after balloon pulmonary valvuloplasty at Ain Shams university hospital from August 2015 to February 2016.
All the patients included in the study performed full echocardiographic examination two years or more after BPV.
The patients included 28 females (40 %) and 42 males (60 %) with a mean age of 2.39 years (range from 1 month to 8.5 years) at the time of the procedure.
There was a progressive DROP in the PG across the PV by Doppler echocardiogram throughout a follow-up period of more than 2 years from a mean of 81.06 ± 20.75 mmHg to a mean of 18.46 ± 8.25 mmHg.
The PV annulus increased after BPV from 10.93± 2.75 mm to 14.75 ± 3.32 mm.
The right ventricular pressure decreased after BPV from 106.07±25.48 mmHg to 26.90±5.96 mmHg.
At follow up, there was a significant increase in patients with PR, 49% had mild PR, 15.7% had moderate PR, 4.3% had severe PR.
There was a significant increase in patients with moderate TR from 4.3% before BPV to 11.4% at follow up after BPV and a significant decrease in patients with severe TR from 5.7% before BPV to 0% at follow up after BPV.
At follow up, the patients with valvular obstruction had significantly lower PG than the patients with both valvular and supravalvular obstruction.
The patients were divided into 2 groups: (A) those in which the balloon/pulmonary annulus ratio was 1.3 or less and (B) those in which the ratio was more than 1.3.
As regard PG at follow up and PG percentage change, there was no significant difference between the 2 groups.
As regard TR at follow up, there was a significant difference between the two groups. group (A) had lower degree of TR as 97.7% of the patients had mild TR and 2.3% had moderate TR, while group (B) had higher degree of TR as 74.1% had mild TR and 25.9 % had moderate TR.
As regard PR at follow up, there was also a significant difference between the two groups. group (A) had lower degree of PR as 16.3% had no PR, 74.4% had mild PR, 7% had moderate PR and 2.3 % had severe PR, while group (B) had higher degree of PR as 63% had mild PR, 29.6% had moderate PR and 7.4% had severe PR.
The study concluded that balloons larger than the PV annulus are recommended for pulmonary valvuloplasty, but performing the procedure with smaller balloon annulus ratio (≤ 1.3) produces significantly less pulmonary insufficiency without reducing the procedure efficacy and that balloon annulus ratio and immediate residual gradient after BPV are determinant factors in achieving good long-term results with percutaneous balloon valvuloplasty.