Application of echocardiography-guided percutaneous balloon pulmonary valvuloplasty in children

Objective To evaluate the application of echocardiography in guiding percutaneous balloon pulmonary valvuloplasty in children, and to summarize the key echocardiographic planes used in the procedure. Methods From February 2013 to September 2015, 38 isolated congenital pulmonary valve stenosis patients were recruited. Case inclusion criteria: age ≥3 years old, purely congenital pulmonary valve stenosis and pulmonary transvalvular pressure gradient ≥40 mmHg. Echocardiography was used to assess the severity of pulmonary valve disease, and to measure pulmonary transvalvular pressure gradient before procedure.Intraoperative transthoracic or transesophageal echocardiography was used to monitor the whole process of percutaneous balloon pulmonary valvuloplasty, and to evaluate immediate postoperative efficacy of the procedure. All patients were followed up by echocardiography after a month post-discharge. Results Thrity eight cases were successfully treated by echocardiography-guided percutaneous balloon pulmonary valvuloplasty. The average age of children was (7.1±2.5)years, mean body weight was(25.3±7.1)kg. Before the procedure, pulmonary transvalvular pressure gradient was(65.9±8.9)mmHg, pulmonary annular diameter was (14.6±1.1)mm. Immediate postoperative pulmonary transvalvular pressure gradient was(15.5±3.4)mmHg. All children survived and had no significant complications. After a month, pulmonary transvalvular pressure was(16.1±3.3)mmHg. Conclusions Echocardiography plays an important role in percutaneous balloon pulmonary valvuloplasty for children with congenital pulmonary valve stenosis. As a non-x ray guided way, it has advantages in preoperative screening of patients, intraoperative real-time monitoring and postoperative assessment of efficacy. The key sections of echocardiography for intraoperative monitoring are four-chamber and aortic short axis view. Key words: Echocardiography; Pulmonary valve stenosis; Cardiac valve valvuloplasty