Retrospective Analysis In 95 Patients With Pulmonary Stenosis Treated With Percutaneous Balloon Pulmonary Valvuloplasty

Objectives To retrospective analyze the hospital information and follow-up data of the patients with pulmonary stenosis (PS) who underwent percutaneous balloon Pulmonary palvuloplasty (PBPV), aim to find out their clinical characters, evaluate the effectiveness of PBPV and find out the influencing factors of effect.Methods This study comprised 95 patients with pulmonary valve stenosis undergoing percutaneous balloon pulmonary valvuloplasty from 1993 to 2008 in our hospital. We retrospective analyzed the data before and after the PBPV, which included main clinical symptoms, signs, electrocardiograms (ECG), the heart's X-ray, transthoracic Doppler echocardiography (TTE), the parameters in the PBPV and the follow-up information.Results1 The clinical characters 49.5% (47/95) of these patients have clinical symptoms, 72.6% (69/95) of them had been touched the thrills on the place of pulmonary valve and all of them had cardiac murmurs on the same place. After the PBPV the symptoms obvious decrease, the murmurs become weak and the thrill almost disappeared. In our study, we found that 70.8% (63/89) of these patients with right ventricle hypertrophy in ECGs. In the 79 patients' heart's X-ray data 58.2% (46/79) of them is found the hearts enlarged. In the 82 patients' TTEs before PBPV, we found that the pulmonary transvalvular gradient assessed by TTEs is (74.29±42.16)mmHg.2 Immediate Result 94 patients succeeded, the technical successful rate was 98.9%. After the procedure, the peak-to-peak pulmonary transvalvular gradient (PTG) and the right ventricular systolic pressure significantly decreased (P<0.01), and the pulmonary systolic pressure significantly increased (P<0.01). Immediate after the PBPV, there are 87.2% patients reach the upper good level. In the mild, the moderate and the severe PS patients ,their immediate PTGs after PBPV are much lower than those before PBPV (P<0.01). It is also notable difference in these patients' results (P<0.01). The PTGs after the PBPV are obvious lower than those before when use either different type balloon or different balloon / pulmonary valve annulus ratio (P<0.01).3 Complications There were 26.6%(25/94) patients appeared complications when immediate after PBPV and 12.0% in follow-up time. The main complications were right ventricular outflow obstruction and convulsion, pulmonary regurgitation and tricuspid regurgitation. Two patients appeared severe complications, one death and one pulmonary artery embolism.4. Follow-up Result The follow-up were performed from 1.0 months to 87.0 months. Every PTG after PBPV was obvious lower than that before PBPV (P<0.01).These follow-up PTGs were decreasing trend by the longer follow time but not obvious (P>0.05).5. The influencing factors We analysis these factors: sex, age, symptoms, murmurs, thrills, PS with ASD or not, PTG before PBPV, balloon / pulmonary valve annulus ratio, balloon type, ECGs and heart's X-ray. We found that only the degree of the stenosis is the strong negative influencing factor of the effect. The higher PTG, the worse effect.Conclusions PBPV is a safe and effective treatment for patient with PS. The immediate and short- media-term results are excellent And the severe complications are few. The degree of the stenosis is a influencing factor of the effect.