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Occasionally surgical intervention may become necessary when there is severe supravalvar stenosis, significant valve annulus hypoplasia, severely dysplastic pulmonary valves, or persistent and severe infundibular narrowing (most of this resolves spontaneously or with beta-blocker therapy) despite successful balloon pulmonary valvuloplasty25.
The waisting of the balloon may be produced by supravalvar stenosis or infundibular constriction.
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