Specific to the procedure:
Once the railroad is established from the vein in the groin across the pulmonary valve, an appropriate sized balloon is taken over the wire to the valve and the balloon is then inflated to open up the commisures which were causing the block.
How is the size of the balloon decided ?
The size of the balloon is decided on the basis of the annulus (ring) of the valve. Maximum up gradation of the balloon size can be 120% of the annulus size.
Can it be determined during the procedure whether the ballooning is effective or not?
Yes, it is mandatory that after the ballooning the pressure difference across the valve is measured again and determined that it is reduced from what it was. Pictures of the pressure tracings can be recorded and are shown in accompanying pix.
What are the statistics?
All pulmonary valve ballooning results are successful if the valve size (annulus-ring size) is adequate; if the narrowing is at the valve itself and if the valve narrowing is not above the valve (s up ravalvar).
Less than 5% children will require a repeat ballooning if the procedure has been performed at more than one month of age.
If the procedure has been performed less than one month of age, the re-ballooning rate is going to be 10%.
Considering this, the procedure is labeled as curative !
What are the complications?
Complications, if at all, happen in the newborn. These maybe transient and may require temporizing treatment. Rarely complications requiring urgent surgery have been reported.
Are Blood products required?
Not usually for the non-neonatal cases, but for the neonatal cases blood products maybe required.
The recovery is very rapid. There is no need for prolonged ICU stay apart from the period of post-anesthesia recovery. Usual groin precautions are to be noted in the first 24 hours.
In neonatal cases in case they required ventilation, the ICU stay maybe longer. It is our preference not to be ventilating newborns electively.