Use of the Accura Balloon for Pulmonary Valvotomy across Age Groups: A Three-Patient Case Series

Background: Severe valvular pulmonary stenosis (PS) in adults and elderly patients is uncommon and technically challenging due to large annuli, dysplastic or calcified valves, and suboptimal performance of standard balloons. The Accura balloon—originally designed for mitral valvotomy—may provide mechanical advantages in such anatomies. Methods: This case series describes three patients with severe PS across a wide age spectrum: an adult with a large annulus (Case 1), an elderly patient with RV dysfunction and ASD (Case 2), and a 13-kg child with combined lesions (Case 3). Conventional balloons were either unsuccessful or unsuitable, and the Accura balloon was used for pulmonary valvotomy. Results: Accura balloon valvotomy produced complete waist formation, significant gradient reduction, and stable hemodynamics in all cases. Conclusion: The Accura balloon is feasible, safe, and effective in resistant, large-annulus, calcific, or complex PS across age groups, particularly when standard balloons fail. Its role should be considered complementary or as a bailout device rather than a replacement for standard balloons.