Outcomes after Balloon Pulmonary Valvuloplasty for Critical Pulmonary Stenosis: A Tunisian reference center experience

Abstract

INTRODUCTION: Balloon pulmonary valvuloplasty (BPV) has emerged as the standard of care for critical pulmonary stenosis (CPS) in newborns. The aim of this study was to describe BVP results for CPS in a North African country where data are scarce. METHODS: A monocentric retrospective descriptive study was conducted on neonates who underwent BPV for CPS between 2000 and 2023, with a minimum clinical and echocardiographic follow-up of 12 months. Primary endpoint was immediate procedural success rate, and secondary endpoints were early additional procedures and late reinterventions. RESULTS: Thirty-four newborns were included. Median age was 10 days [4-17]. Gender-ratio was 1.4. Procedural success was observed in 73%. Six deaths (18%) were noted (two per-procedural and four during in-hospital phase). Early additional procedures were required in 16 patients (50%) consisting of prolonged prostaglandin-E1 infusion, three early BPV-redo and one early Blalock-Taussig shunt surgery. At 3-year median follow-up [1-5], six late reinterventions were reported in five patients (18%), for recurrent valvular or fixed subvalvular obstruction of the right ventricle (RV) outflow tract. These included four late BPV-redo and two late surgeries. Incomplete results, bipartite RV and severe dynamic infundibular stenosis were associated with early additional procedures. The balloon-to-annulus ratio was significantly smaller in those requiring late reintervention (1.12±0.17 vs. 1.33±0.17, p=0.004). CONCLUSION: BPV was an effective treatment for neonatal CPS, with an incompressible rate of additional early procedures related to incomplete results or bipartite RV, and late reinterventions often driven by recurrent valvular or fixed subvalvular obstruction of the RV outflow tract.