Use of Percutaneous Balloon Pulmonary Valvuloplasty as a Palliative Procedure for Conotruncal Anomalies with Subarterial Ventricular Septal Defect

Abstract

Background: Conotruncal anomalies can cause severe cyanosis that requires intervention in the neonatal and early infantile period.
Objectives: To evaluate the effectiveness and outcomes of using balloon pulmonary valvuloplasty （BVP） as an initial palliative procedure in such cases, particularly in those with subarterial ventricular septal defects.
Materials and Methods: Between August 2002 and December 2012, 9 infants （8 males and 1 female） with conotruncal anomalies （3 with tetralogy of Fallot, 4 with double outlet right ventricle, and 2 with congenitally corrected transposition of the great arteries） underwent BVP. Echocardiographic and catheterization data, as well as the patients’ clinical course, were retrospectively examined.
Results: The mean balloon to annulus ratio （B/A ratio） was 1.08 ± 0.15. Moreover, the mean systemic oxygen saturation increased from 75% ± 6% before BVP to 87% ± 7% after BVP （p <0.001）； however, no significant changes in peak velocity and peak pressure gradient at the right ventricular outflow tract were noted, and only minimal pulmonary regurgitation occurred. All the patients, except for 1 with tracheomalacia, were discharged without the need for home oxygen therapy. One patient subsequently required pulmonary arterial banding due to pulmonary over-circulation. No deaths were noted, and definitive repair was achieved in all the patients.
Conclusion: As an initial palliative procedure, BVP involving a relatively smaller balloon size is less invasive, and provides appropriate pulmonary blood flow and bridge to the definitive surgery.