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Brain & Heart Pictorial rendition pulmonary stenosis

Figure 39. The grading system used in quantifying the degree of
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pulmonary insufficiency following balloon pulmonary valvuloplasty.
Modified from Rao et al. 21
Figure 37. Actuarial event-free levels following balloon pulmonary
valvuloplasty (BPV). Out of the total cohort, 10 patients underwent repeat
BPV, three required surgery to relieve right ventricular infundibular
stenosis, and two patients underwent surgery for supravalvar pulmonary
artery stenosis during follow-up. The event-free rates were calculated
using the Kaplan-Meyer method. These rates at 5 and 10 years after BPV
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were in the mid-to-high 80s. Modified from Rao et al. 21

Figure 40. End-diastolic dimensions of the right ventricle before balloon
pulmonary valvuloplasty (BPV) (Pre), the day after BPV (Post), and at
follow-up at intermediate-term (ITFU), and at long-term (LTFU). The
right ventricular dimension decreased (P < 0.05) after BPV, while no
further increase/decrease (P > 0.1) occurred at ITFU and LTFU, signifying
no evidence of the right ventricular dilatation at follow-up secondary to
Figure 38. The incidence of pulmonary insufficiency (PI) observed pulmonary insufficiency, as described in Figure 38. While not shown in
following balloon pulmonary valvuloplasty (BPV). The grading system this graph, end-diastolic dimensions of the left ventricle did not alter. 21
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used is shown in Figure 39. An increase in the degree of PI (P < 0.001) Abbreviation: SD: Standard deviation. Modified from Rao et al. 21
occurred following BPV (Pre [before BPV] vs. Post [day after BPV]). At
intermediate-term (ITFU), there was no significant change in the degree
of PI (P > 0.1). However, at long-term follow-up (LTFU), the PI increased In response, the author has revised the recommendations
when compared with ITFU (P < 0.05). Modified from Rao et al. 21 for B/A ratios to be used for BPV from prior 1.2 – 1.4 to 1.2
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– 1.25 in an editorial communication, a revision reiterated
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of flat interventricular septal motion (Figure 41). Based on in subsequent publications. 17,48,49 Several investigations into
the study, the author and colleagues endorsed BPV as the the causes of the development of PI at long-term follow-up
preferred management for valvar PS, albeit with reservations after BPV 64,66,67 have identified a common denominator, a
about the potential adverse effects of PI on long-term large B/A ratio. 64,66,67 Although it remains unclear whether
follow-up. Rao et al. recommended a follow-up evaluation reducing the B/A ratio will mitigate or eliminate the risk
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spanning 10 – 20 years to determine the significance of of PI, a recent study by Pathak et al. suggested a favorable
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PI. Subsequent to the Rao et al. publication, Berman et effect in significantly reducing PI, albeit with a follow-up
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al. reported a significant development of PI requiring duration of only 15 months. Long-term follow-up studies
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pulmonary valve replacement in 6% of their study subjects. are eagerly awaited to confirm these observations.

Volume 2 Issue 1 (2024) 12 https://doi.org/10.36922/bh.2406