Abstract
Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.
Highlights
Isolated pulmonary valve (PV) stenosis is a relatively common disorder, accounting for 7-8% of congenital heart disease (CHD)[1]
Transvalvular mean pressure gradient decreased in the entire patient population, but right outflow tract reintervention rate was greater in Group 1 (14.10% vs 2.3%, p = 0.04)
At a mean follow-up interval of 4.9 ± 33 years, pulmonary valve insufficiency was severe in 2.47% of patients in Group 1, whereas it was mild to moderate in 33.3% of patients in Group 2, the latter having undergone unsuccessful percutaneous balloon valvuloplasty prior to surgery in the vast majority of cases (14/20 vs 6/22, p=0.023)
Summary
Isolated pulmonary valve (PV) stenosis is a relatively common disorder, accounting for 7-8% of congenital heart disease (CHD)[1]. Surgical treatment of pulmonary stenosis was subsequently challenged in 1982 when Kan reported successful percutaneous balloon valvuloplasty (PBV)[5]. This method of therapy is applied as the initial procedure of choice[6],[7] to patients of all ages, should be used with caution in cases within case of PV dysplasia[8]. Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. We sought to analyze the effect of such evolving philosophy on mid-term results
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