Immediate Results of Balloon Pulmonary Valvuloplasty in Young Children with Pulmonary Valve Stenosis and Impaired Right Ventricular Function

Abstract

Objectives: This study evaluated the immediate procedural outcomes, complications, and predictors of adverse events following balloon pulmonary valvuloplasty (BPV) in infants and young children with impaired right ventricular (RV) function. Methodology: This prospective observational study included consecutive children weighing less than 10 kg who underwent BPV for isolated moderate-to-severe valvular pulmonary stenosis at a tertiary pediatric cardiac center between July 2006 and June 2024. Patients were categorized according to baseline RV systolic function using predefined echocardiographic criteria. Demographic characteristics, procedural variables, hemodynamic measurements, procedural success, and peri-procedural complications were prospectively recorded and compared between children with normal and impaired RV function. Binary logistic regression analysis was performed to identify factors independently associated with procedural complications. Results: A total of 368 children underwent BPV during the study period, including 93 (25.3%) with impaired RV function. Overall procedural success was achieved in 342 patients (92.9%). Children with impaired RV function had significantly lower procedural success than those with preserved RV function (88.2% vs. 94.5%; p=0.038) and experienced significantly longer procedure and fluoroscopy times. Procedural complications occurred in 52 children (14%), whereas serious complications occurred in eight patients (2%). Arrhythmias and cardiopulmonary resuscitation were significantly more frequent in children with impaired RV function. Binary logistic regression demonstrated that impaired RV function independently increased the likelihood of procedural complications (OR=2.5, 95% CI 1.34–4.70; p=0.004). Despite the increased procedural risk, 99% of children with impaired RV function demonstrated early improvement in RV systolic function within 24–48 hours after intervention. Conclusion: Balloon pulmonary valvuloplasty provides excellent immediate hemodynamic and clinical outcomes in infants and young children with significant valvular pulmonary stenosis, including those with impaired RV systolic function. Although impaired RV function is associated with a higher risk of peri-procedural complications, successful intervention can be achieved in the majority of patients when meticulous procedural planning, careful catheter manipulation, comprehensive hemodynamic monitoring, and appropriate balloon sizing are employed.