Journal of JCIC

Recently percutaneous transluminal pulmonary valvuloplasty (PTPV) has gained acceptance as the first option in the management of congenital pulmonary valve stenosis. It is generally recommended that the procedure be performed for peak-to-peak gradients ≧40 mmHg with standard-pressure balloons with balloon/annulus ratio of 1.2 to 1.25. The duration of inflation is kept as short as possible to minimize blocking pulmonary blood flow. Immediate after PTPV, β-blockade therapy is generally recommended if significant stenosis of right ventricular outflow tract occur. When the pulmonary valve annulus is too large to dilate with a single balloon, double balloon valvuloplasty may be performed. Because there is limitation of use of stents for vascular stenosis in Japan, many interventional cardiologists tend to perform percutaneous transluminal angioplasty (PTA) as the first option in the management of pulmonary artery stenosis which is either native or post-surgery. It is generally recommended that the procedure be performed for gradients ≧20 mmHg, pressure-ratio of proximal pulmonary artery (or right ventricle)/systemic artery ≧0.7, or perfusion-ratio of affected lung/healthy lung ≦0.5. The recommendation is to use high-pressure balloons that have diameter of 3.0–3.5 times the most stenotic regions and less than 1.5 times the reference vessels. If the lesion is too hard, the recommendation is to use ultra-high-pressure balloons (≧15 atms) that have diameter approximately 2.0 times the most stenotic regions. If PTA is ineffective, alternative equipment such as cutting balloons or implantation of stents may be considered.