Background: Percutaneous balloon pulmonary valvuloplasty (PBPV) has replaced surgery and is the gold standard as the initial intervention for patients with moderate to severe pulmonary valve stenosis (PVS). Despite the limited resources in Guatemala, PBPV is the primary treatment for PVS at Unidad de Cirugía Cardiovascular de Guatemala (UNICAR). We sought to analyze the results of PBPV in a limited resource country.

Methods: We conducted a retrospective chart review of all patients who underwent cardiac catheterization from January 2006 to December 2019 and identified those who underwent PBPV. Patients with concomitant major cardiac defects and incomplete medical records were excluded. Hemodynamic data from PBPV catheterization, and clinical and echocardiographic data before and after PBPV was collected. Primary endpoints were PBPV success, need for second PBPV or surgery after PBPV, and mortality. Success was defined as a final pulmonary valve-pressure gradient (PVPG) <35mmHg or a decrease ≥50% of pre-PBPV gradient. Paired t-test was used for statistical analysis.

Results: Sixty-one patients, 31 females (51%), were included in the study, with a median age 2.5 years (interquartile range [IQR] 6.5 months – 7.5 years). On pre-PBPV evaluation, 90% of patients had a World Health Organization functional class 1, and 75% had oxygen saturation >93%. On pre-PBPV echocardiogram, 33 (54%) patients had a PVPG >80mmHg, and pulmonary valve was described as thickened tricuspid 47% (n=29), thickened bicuspid 16% (n=10), or other 37% (n=22). PBPV was successful in 87% (n=53) of patients. During catheterization, the median PVPG pre-PBPV was 72mmHg (IQR 51-78mmHg) and the median post-PBPV gradient was 24mmHg (IQR 13–34mmHg) (p<0.001). Similarly, median right ventricle-to-systemic pressure ratio decreased from 1:1 pre-PBPV (IQR 0.5–1.35:1) to 0.6:1 post-PBPV (IQR 0.44–0.82:1) (p<0.001). The balloon-to-pulmonary valve ratio was 1.2-1.5:1, and 49 (80%) patients required >1 balloon dilation. Two patients required a second catheterization and PBPV and none required surgery. Mortality was 6.5% (4 patients), all of whom had severe PVS and age <3 months. Fifty-seven (93%) patients survived to discharge. On post-PBPV echocardiogram the PVPG decreased to a median 24mmHg (IQR 14.5-39mmHg) (p<0.001), and only 13 patients had more than mild pulmonary valve regurgitation.

Conclusions: PBPV is performed at UNICAR with a high success rate and low mortality. This procedure should continue to be the preferred treatment for moderate to severe PVS in Guatemala. Young infants and neonates with severe PVPG should be managed with caution, as they have a greater risk of mortality.