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Brain & Heart

PERSPECTIVE ARTICLE
Pictorial rendition of author’s observations

on balloon valvuloplasty/angioplasty
procedures: Pulmonary stenosis

P. Syamasundar Rao*

Department of Pediatrics, Children’s Heart Institute, University of Texas-Houston McGovern Medical School,
Children’s Memorial Hermann Hospital, Houston, Texas, USA

Abstract

Balloon valvuloplasty/angioplasty techniques have been available to address valvar
and vascular obstructions associated with congenital heart defects (CHDs) since the
1980s. The objective of this paper is to provide a pictorial rendition of the author’s
observations over the last four decades on these techniques. In this paper, balloon
pulmonary valvuloplasty (BPV) for treating isolated pulmonary stenosis (PS), PS
associated with cyanotic CHDs, and bioprosthetic valve in the pulmonary position
were reviewed. Balloon dilatation leads to a decrease in the peak systolic pressure
gradient through the pulmonary valve during BPV, as well as at intermediate-term
and long-term evaluation. Problems, such as the reappearance of obstruction
at intermediate-term follow-up and pulmonary insufficiency (PI) at long-term
follow-up, have been documented in isolated PS cases but are infrequent. Repeat
balloon valvuloplasty for restenosis has been successfully used. The development of
infundibular obstruction in PS cases was also reviewed. To decrease the frequency
*Corresponding author: and degree of PI, the author has revised the recommendations for balloon/annulus
P. Syamasundar Rao ratios used for BPV from the previous 1.2 – 1.4 to 1.2 – 1.25. In patients with PS
(P.Syamasundar.Rao@uth.tmc.edu) associated with cyanotic CHD, improvement of oxygen saturations at the time of BPV
Citation: Rao PS. Pictorial and enhanced anatomy during follow-up were observed. BPV of bioprosthetic valves
rendition of author’s observations results in minimal improvement in the pulmonary valve gradient, and stents may be
on balloon valvuloplasty/angioplasty
procedures: Pulmonary stenosis. a better alternative to address this problem.
Brain & Heart. 2024;2(1):2406.
https://doi.org/10.36922/bh.2406
Keywords: Balloon pulmonary valvuloplasty; Restenosis; Pulmonary insufficiency;
Received: December 12, 2023 Infundibular stenosis; Long-term follow-up results; Cyanotic heart defects; Bioprosthetic
Accepted: January 23, 2024 valves
Published Online: February 15, 2024
Copyright: © 2024 Author(s).
This is an Open-Access article 1. Introduction
distributed under the terms of the
Creative Commons Attribution In 1964, Dotter and Judkins performed dilatation of peripheral arteries with progressively
License, permitting distribution,
1
and reproduction in any medium, increasing sizes of guidewires and catheters, resulting in favorable outcomes. Dotter
provided the original work is and Judkins’ principle was later extended by Grüntzig et al., who created catheters with
properly cited. double-lumen and non-flexible balloons to effectively dilate stenotic peripheral, renal,
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Publisher’s Note: AccScience and coronary arterial lesions. Grüntzig’s balloons were utilized by Kan et al., Singer
Publishing remains neutral with et al., Sperling et al., and Lababidi to alleviate congenital cardiac narrowing of the valves
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regard to jurisdictional claims in
published maps and institutional and blood vessels in children. In 1966, Rashkind and Miller introduced balloon atrial
affiliations. septostomy to promote blood mixing at the atrial level in babies with transposed great
Volume 2 Issue 1 (2024) 1 https://doi.org/10.36922/bh.2406