Mid to long-term effect of balloon pulmonary valvuloplasty on right ventricle function: a three-dimensional echocardiographic study

Abstract Background Right ventricular (RV) remodelling may persist after balloon pulmonary valvuloplasty (BPV) for isolated valvular pulmonary stenosis (PVS). Three-dimensional echocardiography (3DE) enables global RV volumetric assessment beyond conventional 2D indices. Methods This cross-sectional observational study included 200 pediatric patients (≤ 18 years) with isolated PVS who underwent successful BPV (post-procedural peak gradient < 36 mmHg) at least 1 year before evaluation. All patients had clinical assessment, ECG, standard 2D/Doppler echocardiography (TAPSE, S′, FAC), and ECG-gated 3DE RV quantification to derive RV end-diastolic and end-systolic volume indices and right ventricular ejection fraction (RVEF). Patients were classified into 2 groups; group 1 had normal RVEF (≥ 45%) and group 2 had impaired RVEF (< 45%). Results RVEF was normal in 71% ( n = 142) and impaired in 29% ( n = 58). Group 2 was associated with; older age at assessment (median 120 vs. 72 months, p < 0.001), later intervention (median age at BPV 24 vs. 3 months, p < 0.001), and longer time since BPV (96 vs. 68 months, p = 0.004). it also showed association with higher pre-dilatation peak gradients (97.24 ± 26.47 vs. 83.8 ± 24.61 mmHg, p = 0.017) and higher post-dilatation gradients (30.97 ± 9.81 vs. 23.56 ± 8.59 mmHg, p < 0.001). Group 2 also had lower conventional RV function indices: S′ 12.64 ± 3.22 vs. 15.01 ± 1.09 cm/s, TAPSE 16.28 ± 2.75 vs. 19.21 ± 1.72 mm, and FAC 39.86 ± 5.21 vs. 49.8 ± 2.62% (all p < 0.001). by using 3DE interrogation, group 2 showed higher RVEDV index (62.0 ± 11.06 vs. 43.14 ± 11.44, p < 0.001) and RVESV index (34.41 ± 8.24 vs. 22.76 ± 6.65, p < 0.001) . Conclusions At ≥ 1 year after successful BPV, nearly one-third of children showed impaired 3DE-derived RVEF, associated with older age at intervention, higher residual gradients, and RV dilatation, patients with RV impairment were underestimated when assessed by 2D vs. 3D echo, supporting the role of 3DE in long-term surveillance.