Seventeen years of follow-up show that pulmonary balloon valvuloplasty reduces the severity of infundibular stenosis and tricuspid regurgitation, with sustained improvement in cardiac index. Seventeen years of follow-up show that pulmonary balloon valvuloplasty reduces the severity of infundibular stenosis and tricuspid regurgitation, with sustained improvement in cardiac index.

A study of 90 patients with congenital pulmonary valve stenosis, mean age 23 years, was conducted by a team led by Dr. Mohamed Eid Fawzy at King Faisal Hospital in Riyadh, Saudi Arabia.

Clinical and echocardiographic follow-up was performed for a mean of ten years, and up to 17 years in some cases.

There were 43 patients with moderate to severe concomitant infundibular stenosis, with an infundibular gradient of 30 mmHg or less. This group underwent repeat cardiac catheterization six to 24 months after pulmonary balloon valvuloplasty.

Dr. Fawzy and colleagues report in the March issue of the American Heart Journal that there were no immediate or late deaths in this series. The mean catheter peak pulmonary gradient before pulmonary balloon valvuloplasty was 105, falling to 34 immediately after the procedure. Right ventricular pressure was 125 mm Hg before pulmonary balloon valvuloplasty and 59 mm Hg afterward.

The infundibular gradient, measured in 43 patients immediately after pulmonary balloon valvuloplasty, was 42.9 mmHg. On repeat cardiac catheterization, it had regressed to 13.5 mmHg. Cardiac index also improved significantly (p< 0.05).

Doppler pulmonary gradient averaged 91 mmHg immediately before pulmonary balloon valvuloplasty, dropping to 28 mm Hg at one year, and to 26 mm Hg at long-term follow-up.

Significant tricuspid regurgitation either regressed significantly or disappeared completely at long-term follow-up. New mild pulmonary regurgitation developed in 28 per cent of patients.

The Riyadh team concludes that "the immediate hemodynamic results were similar to those reported in infants and children, and the hemodynamic improvement was sustained for up to 17 years of follow-up...Hence, pulmonary balloon valvuloplasty should be considered as the treatment of choice for adult patients with pulmonary valve stenosis with or without concomitant infundibular stenosis and/or severe tricuspid regurgitation.