High-pressure balloon valvuloplasty for severe pulmonary valve stenosis

A prospective observational pilot study in 25 dogs

Catherine Belanger, Catherine Gunther-Harrington, Satoko Nishimura, Maureen S. Oldach, Samantha L. Fousse, Lance C Visser, Joshua A Stern

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: We aimed to evaluate safety and efficacy of high-pressure balloon valvuloplasty (HPBVP) for treatment of canine severe pulmonary valve stenosis (PS). A secondary aim was to provide pre-procedure predictors of success. Animals: Twenty-five dogs. Methods: Prospective observational study. Dogs with severe PS (echocardiographically derived trans-pulmonary peak/maximum pressure gradient (EDPG) ≥80 mmHg) were recruited. All dogs underwent echocardiography before and 20-24hrs after HPBVP using a high-pressure balloon with rated burst pressures ranging from 12 to 18 ATM. Procedural success was defined as a post-HPBVP EDPG reduction of ≥50% or reduction into at least the moderate category of PS (50-79 mmHg). Optimal result was defined as a post-procedural EDPG ≤30 mmHg. Results: Initial median (IQR) EDPG for all dogs was 96 (88, 127) mmHg with a post-operative median of 48 (36, 65) mmHg. The median EDPG reduction provided by HPBVP was 63% (39, 68); procedural success rate was 92% (23 dogs). Optimal results were achieved in 56% (14 dogs). There were no significant correlations between EDPG reduction and valve morphology (Type A and Type B) or severity of right ventricular hypertrophy. Pulmonary valve annulus diameter was the only echocardiographic variable that was significantly correlated to EDPG reduction (p = 0.02; r = -0.46). No dog experienced any anesthetic or surgical complications, and all patients survived the procedure. Conclusions: In this cohort of 25 dogs with severe PS, HPBVP was safe and effective. The procedural success rate and high number of optimal results achieved with HPBVP suggest future randomized controlled trials comparing HPBVP to conventional valvuloplasty are warranted.

Original languageEnglish (US)
JournalJournal of Veterinary Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Balloon Valvuloplasty
Pulmonary Valve Stenosis
Observational Studies
lungs
Dogs
Pressure
dogs
Right Ventricular Hypertrophy
Pulmonary Valve
echocardiography
observational studies
hypertrophy
anesthetics
Echocardiography
Anesthetics
Canidae
Randomized Controlled Trials
Prospective Studies

Keywords

  • Balloon dilation
  • Congenital heart disease
  • Interventional radiology
  • Pulmonic stenosis

ASJC Scopus subject areas

  • Physiology
  • veterinary(all)

Cite this

High-pressure balloon valvuloplasty for severe pulmonary valve stenosis : A prospective observational pilot study in 25 dogs. / Belanger, Catherine; Gunther-Harrington, Catherine; Nishimura, Satoko; Oldach, Maureen S.; Fousse, Samantha L.; Visser, Lance C; Stern, Joshua A.

In: Journal of Veterinary Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objectives: We aimed to evaluate safety and efficacy of high-pressure balloon valvuloplasty (HPBVP) for treatment of canine severe pulmonary valve stenosis (PS). A secondary aim was to provide pre-procedure predictors of success. Animals: Twenty-five dogs. Methods: Prospective observational study. Dogs with severe PS (echocardiographically derived trans-pulmonary peak/maximum pressure gradient (EDPG) ≥80 mmHg) were recruited. All dogs underwent echocardiography before and 20-24hrs after HPBVP using a high-pressure balloon with rated burst pressures ranging from 12 to 18 ATM. Procedural success was defined as a post-HPBVP EDPG reduction of ≥50{\%} or reduction into at least the moderate category of PS (50-79 mmHg). Optimal result was defined as a post-procedural EDPG ≤30 mmHg. Results: Initial median (IQR) EDPG for all dogs was 96 (88, 127) mmHg with a post-operative median of 48 (36, 65) mmHg. The median EDPG reduction provided by HPBVP was 63{\%} (39, 68); procedural success rate was 92{\%} (23 dogs). Optimal results were achieved in 56{\%} (14 dogs). There were no significant correlations between EDPG reduction and valve morphology (Type A and Type B) or severity of right ventricular hypertrophy. Pulmonary valve annulus diameter was the only echocardiographic variable that was significantly correlated to EDPG reduction (p = 0.02; r = -0.46). No dog experienced any anesthetic or surgical complications, and all patients survived the procedure. Conclusions: In this cohort of 25 dogs with severe PS, HPBVP was safe and effective. The procedural success rate and high number of optimal results achieved with HPBVP suggest future randomized controlled trials comparing HPBVP to conventional valvuloplasty are warranted.",
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AU - Belanger, Catherine

AU - Gunther-Harrington, Catherine

AU - Nishimura, Satoko

AU - Oldach, Maureen S.

AU - Fousse, Samantha L.

AU - Visser, Lance C

AU - Stern, Joshua A

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AB - Objectives: We aimed to evaluate safety and efficacy of high-pressure balloon valvuloplasty (HPBVP) for treatment of canine severe pulmonary valve stenosis (PS). A secondary aim was to provide pre-procedure predictors of success. Animals: Twenty-five dogs. Methods: Prospective observational study. Dogs with severe PS (echocardiographically derived trans-pulmonary peak/maximum pressure gradient (EDPG) ≥80 mmHg) were recruited. All dogs underwent echocardiography before and 20-24hrs after HPBVP using a high-pressure balloon with rated burst pressures ranging from 12 to 18 ATM. Procedural success was defined as a post-HPBVP EDPG reduction of ≥50% or reduction into at least the moderate category of PS (50-79 mmHg). Optimal result was defined as a post-procedural EDPG ≤30 mmHg. Results: Initial median (IQR) EDPG for all dogs was 96 (88, 127) mmHg with a post-operative median of 48 (36, 65) mmHg. The median EDPG reduction provided by HPBVP was 63% (39, 68); procedural success rate was 92% (23 dogs). Optimal results were achieved in 56% (14 dogs). There were no significant correlations between EDPG reduction and valve morphology (Type A and Type B) or severity of right ventricular hypertrophy. Pulmonary valve annulus diameter was the only echocardiographic variable that was significantly correlated to EDPG reduction (p = 0.02; r = -0.46). No dog experienced any anesthetic or surgical complications, and all patients survived the procedure. Conclusions: In this cohort of 25 dogs with severe PS, HPBVP was safe and effective. The procedural success rate and high number of optimal results achieved with HPBVP suggest future randomized controlled trials comparing HPBVP to conventional valvuloplasty are warranted.

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