IMMEDIATE RESULTS OF BALLOON VALVULOPLASTY FOR PULMONARY STENOSIS DEPENDING ON THE TYPE OF STENOSIS

Objective: To analyze the immediate outcomes of balloon valvuloplasty (BV) for pulmonary stenosis (PS) based on the type of narrowing.

Materials and Methods: The study included 180 patients with PA and RVOT stenoses who underwent BV at the State Institution "Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V. Vakhidov" from 2010 to 2022. Patients with isolated PA valve stenosis were included. Exclusion criteria were critical PA stenosis, pregnancy, and complex congenital heart disease. Patients were categorized by initial right ventricular (RV) systolic pressure: ≤100 mm Hg (43.3%), 101-150 mm Hg (30.0%), 151-200 mm Hg (16.7%), and >200 mm Hg (10.0%). To determine the dependence of the results on the type of PA obstruction, patients were divided into the following groups: valvular PS (n=144), valvular-subvalvular PS (n=27), valvular-supravalvular PS (n=9).

Results: In isolated valvular PS (n=144), RV systolic pressure decreased from 118.2±14.7 mm Hg to 55.1±6.3 mm Hg, PA pressure increased from 22.9±2.7 mm Hg to 28.5±2.9 mm Hg, and the RV-PA pressure gradient dropped from 94.0±10.4 mm Hg to 26.3±3.1 mm Hg. Good results were seen in 79.2%, satisfactory - in 13.9%, and unsatisfactory - in 6.9% of patients. For combined valvular-subvalvular PS (n=22), RV pressure decreased from 148.6±16.8 mm Hg to 82.4±7.2 mm Hg, PA pressure increased from 21.3±2.5 mm Hg to 27.0±3.6 mm Hg, and the gradient fell from 129.1±14.3 mm Hg to 56.7±6.2 mm Hg. Good outcomes were achieved in 44.4%, satisfactory - in 33.3%, and unsatisfactory - in 22.2%. In valvular-supravalvular PS (n=9), RV pressure decreased from 130.4±2.5 mm Hg to 55.3±1.9 mm Hg, PA pressure increased to 28.5±1.5 mm Hg, and the gradient dropped from 113.6±1.8 mm Hg to 21.3±1.1 mm Hg. Good results were seen in 77.8% of patients.

Conclusion: BV effectively treats isolated valvular PS, significantly improving clinical and hemodynamic outcomes. The procedure is also beneficial for combined stenoses but with higher residual gradients. For valvular-supravalvular stenosis, BV shows high efficacy despite limited data.