Retrospective Analysis Of 121 Cases Withpercutaneous Balloon Pulmonary Valvuloplasty

Objective The clinical data of patients with pulmonary valve stenosis(PVS)who underwent percutaneous balloon pulmonary valvuloplasty(PBPV)were retrospectively analyzed.On the basis of the guidelines on PBPV,the study focused on age boundary and degree of valve stenosis.The aims were to study clinical characters and clinical efficacy for patients who underwent PBPV,and effect factors of PBPV were concurrently evaluated.Methods The study included 121 patients with PVS who underwent PBPV from January 2011 to January2019.We analyzed the clinical data which included clinical presentation,Electrocardiograms(ECG),X-ray,Transthoracic echocardiography(TTE)and the hemodynamic data.Postoperative pulmonary transvalvular gradient was used as an immediate evaluation index.We explore the clinical efficacy and influencing factors of PBPV by comparing the excellent or good rate of adult subgroups and non-adult subgroups,mild,moderate and severe PVS and different balloon / pulmonary valve annulus(B/A).Results1.71%of the patients have no obvious symptoms,only 28.1% of patients have clinical symptoms,all of them had cardiac murmurs on the place of pulmonary valve and 25.6%of them have been touched the thrills on the same place.Preoperative ECG indicated right ventricular hypertrophy in 70.6%patients.X-ray demonstrate enlargement of the pulmonary artery accounting for57.6%.The right ventricle that have been assessed by TTE was enlarged in70.3% of the patients before PBPV.2.PBPV was successfully completed in 121 patients with PVS.Before the PBPV,the right ventricular systolic pressure(RVP),the pulmonary systolic pressure(PAP)and the pulmonary transvalvular gradient(PTG)were 86.79±30.23 mm Hg,21.69±7.00 mm Hg,65.26±31.51 mm Hg.After the PBPV,RVP,PAP and PTG were 50.61±16.40 mm Hg,25.52±7.58 mm Hg,25.20±15.92 mm Hg,RVP and PTG significantly decreased(all P<0.01),PAP significantly increased(P<0.01).The efficacy of PBPV was93.3% and the incidence of complication was 3%.3.The preoperative RVP,PAP and PTG of adult subgroup were 100.41±27.62 mm Hg,21.64±9.21 mm Hg80.20±28.83 mm Hg.The posto-perative RVP,PAP and PTG of adult subgroup were 53.68±11.73 mm Hg,23.86±5.73 mm Hg,30.17±11.8 mm Hg,The preoperative RVP,PAP and PTG of non-adult subgroup were 82.50±29.75 mm Hg,21.83±17.50 mm Hg,60.55±30.85 mm Hg.The postoperative RVP,PAP and PTG of non-adult subgroup were 49.64±6.14 mm Hg,26.04±8.00 mm Hg,and23.64±16.71 mm Hg.In the adult subgroup and the non-adult sub-group,RVPs and PTGs significantly decreased(all P<0.01)and PAPs increased(P<0.01).After the PBPV,the excellent rate and bad rate of adult subgroup were 96.5%,3.5% and the excellent rate and bad rate of non-adult subgroup were 92.4%,7.6%.There was no significant difference between the two subgroups in the rate of good and bad immediate effects of PBPV(P>0.05).4.For PVS patients with differentvalve stenosisdegrees,PTGs after PBPVwere significantly lower than that before PBPV(all P<0.01).The excellentor good rate of immediate effect in patients with severe valve stenosis(85.7%)was significantly lower than that of mild valve stenosis(100%)and moderate valve stenosis(98.2%)(all P<0.01).The bad rate of immediate effect in patients with severe valve stenosis(14.3%)was significantly higher than that of mildvalve stenosis(0%)and moderate valve stenosis(1.8%)(all P<0.01).5.In 105 patients with PBPV,balloon / pulmonary valve annulus(B/A)ratio was1.21±0.17.121 patients were divided into 3 subgroups according to B/A ratio,B/A ratio<1.2subgroup account for 52.3%,B/A1.2~1.4subgroupaccount for36.2%,B/A>1.4subgroupaccount for11.5%.The PTGs after the PBPVwere lower than those before in different B/Aratio subgroups(all P<0.01).There was no significant difference in the immediateeffect of PBPV among the three different subgroups(all P>0.05).Conclusions1.Most patients with PVS were asymptomatic,but had typical systolic murmurs in the pulmonary valve area.And the manifestations with right ventricular enlargement also very common in their ECG or chest radiographs and TTE.2.The patients with PBPV have good immediate efficacy and low incidence of complication.3.There was no significant difference between adult and non-adult patients in the immediate efficacy of PBPV.The effective rate of PBPV for patients with severe PVS is relatively low,only 85.7%.4.According to the patient's condition,B/A ratiowhich doctor decided isappropriate,there was no significant difference in the immediate efficacy of PBPV in different ranges of B/A ratio.