Determinants for outcome of balloon valvuloplasty for severe pulmonary stenosis in neonates and infants up to six months of age

In older children, many reports have shown that balloon valvuloplasty for valvular pulmonary stenosis is a safe and effective alternative to surgical valvulotomy, and therefore is considered to be the procedure of choice.^1-5 However, in young infants and neonates, the results of balloon valvuloplasty are less satisfactory, with reported failure rates ranging from 17 to 45%.^6-10 The lower success rate may be related to the smaller size of the patients, but also to differences in anatomy of the right ventricle and its valves, and in hemodynamics when compared with those of older children. In addition to the lower success rate, complications of the procedure are more frequent in this age group,^1,7,9 including femoral vein thrombosis, paradoxic emboli and perforation of the myocardium. In this article, we report the experience of 3 Dutch pediatric cardiology centers with nonelective balloon valvuloplasty in children aged < 6 months, with special emphasis on determinants for outcome.