الفهرس 
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Abstract
C
ongenital heart malformations are the most frequent of all major birth defects, with an estimated prevalence at birth of approximately 8-10 cases per 1000 births. Amongst congenital heart disease, pulmonary valve stenosis (PS) accounts for 10% of congenital heart diseases and is accompanied in approximately 20% of congenital heart disease cases.
The procedure is not free of complications, and there is still a significant rate of reintervention during the follow-up period of these patients.
When the degree of valvular pulmonary stenosis (PS) is severe, it causes a decrease in right ventricular output and a larger than normal atrial right to left shunt in utero. Currently, BPV is the standard of care for neonates with severe PS and has been shown to decrease the hospital length of stay and morbidity. As compared with surgical valvotomy.
Morphological heterogeneity regarding the development of right ventricle, tricuspid valve, pulmonary artery, is the main indicator of treatment and the predictor of the eventual outcome.
Our study is aimed at comparing the clinical features, the immediate and short term outcome of BPV of infants with severe pulmonary stenosis who underwent Percutaneous BPV as initial intervention method between patients who underwent reintervention and those who did not in order to evaluate the risk factors for reintervention.
group I: consisted of 28 patients who did not need reintervention, and group II: consisted of the remaining 7patientswhounderwentreintervention during follow-up.
All the relevant pre- and postoperative clinical features including weight, age, admission days, heart rate, blood pressure, SpO2, PaCO2, days of admission after procedure were compared between two groups.
Echocardiographic evaluation of right ventricular (RV) function is a challenge due to the complex anatomy of the RV. Several transthoracic echocardiographic methods have been suggested for the quantification of RV function.
Three-dimensional (3D) echocardiography directly assesses right ventricular (RV) volumes without geometric assumptions, despite the complex shape of the right ventricle, and accordingly is more accurate and reproducible than the two-dimensional methodology, which is able to measure only surrogate parameters of RV function. Volumetric analysis has been hampered by frequent inability to clearly visualize RV endocardium, especially the RV free wall, in 3D echocardiographic images.
The present study was done to comparing the clinical features and the immediate and short term outcome of BPV of infants with severe pulmonary stenosis who underwent Percutaneous BPV as initial intervention method between patients who underwent reintervention and those who did not in order to evaluate the risk factors for reintervention.
Our study was designed to be cross sectional study that includedthirty five patients in the infancy age group (up to one year) with severe pulmonary valve stenosis referred to our congenital and structural heart disease unit cardiology department in Ain shams university hospital for balloon pulmonary valvuloplasty. In the time interval between October 2020 and April 2021.
Three-dimensional Echocardiography was done before Balloon Pulmonary Valvuloplasty and repeated immediately after the procedure to assess the Impact of Balloon Pulmonary Valvuloplasty on RV quantification by offline analysis by the available software.
Our results found no immediate significant rate of reintervention in infants with higher pre- and post-intervention right ventricle systolic pressure also the tricuspid valve annulus diameter and its Z score values are not predictors for reintervention.
In conclusion, based on our study, those with the small pulmonary valve annulus diameter and pulmonary valve Z-score have higher rate of reintervention. A minor immediate DROP in pressure gradient across the pulmonary valve post-intervention is other predictor of reintervention.