Percutaneous Pulmonary Valvuloplasty by JOMIVA Balloon in Adults: Long Term Retrospective Study from a Tertiary Care Hospital of Eastern India

Abstract

Introduction: Isolated pulmonary valve stenosis with intact ventricular septum constitutes the third most common congenital heart disease apart from Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD). Percutaneous balloon pulmonary valvuloplasty is an effective therapeutic alternative procedure of choice in severe valvular PS. Conventionally, the Mansfield balloon is being used worldwide for pulmonary valvuloplasty. Joseph Mitral Valvuloplasty (JOMIVA) balloon offers advantages of longer size, lower cost and its familiarity to use this balloon for mitral valvuloplasty in this institution since long. Aim: To assess the immediate and long-term results of Joseph Mitral Valvuloplasty (JOMIVA)balloon for Pulmonary valvuloplasty in isolated severe Pulmonary Stenosis (PS). Materials and Methods: This was a long term retrospective study conducted at the Cardiology Department of SCB Medical college and Hospital, Cuttack, Odisha, India, where pulmonary valvuloplasty was performed using single JOMIVA balloon in 21 adults and adolescent patients. Clinical and Echocardiography (Echo) Doppler evaluation for restenosis and Pulmonary Regurgitation (PR) were assessed. All the cases were followedup serially in Outpatient Department (OPD) for 12 years in retrospect manner. Results: Data of total 21 participants (15 males and 6 females; mean age was 18.3±6.8 years) were analysed in the study. After pulmonary valvuloplasty, the median transvalvular gradient significantly decreased from 115 mmHg (interquartile range (IQR) 101-128 mmHg) to 46 mmHg (IQR 37-51 mmHg) (p-value<0.0001). Also, the right ventricular systolic pressure reduced significantly from 136 mmHg (IQR 122-148 mmHg) to 67 mmHg (IQR 57-71 mmHg) (p-value<0.0001). Catheterization Laboratory (Cath Lab) complications were transient and selflimiting. Mild to moderate (PR) was noted in all cases i.e., Grade I in 12 cases (57.1%) and Grade II in 9 cases (42.8%) which showed evidence of regression on follow-up. Neither significant restenosis nor significant PR (Grade III /IV) was observed during follow-up period of 12 years. Conclusion: Percutaneous valvuloplasty using JOMIVA Balloon, in case of severe valvular PS in adults, is a cost-effective procedure. It has excellent immediate results, and long-term incremental benefits was observed in this 12-year follow-up study