Surgical treatment for severe pulmonary valve stenosis

Abstract

Objective To evaluate the effectiveness of urgent surgical procedures for severe pulmonary valve stenosis in infants and children. Methods Seventy-four (51 male, 23 female) children with severe pulmonary valve stenosis who received surgical correction were collected from Oct.2006 to Jan.2013.The age of patients ranged from 2 months to 13 years(median age was 26 months), and the body weight was 5-47 kg (median weight was 16 kg). Patients had other cardiac deformities, and among them 20 patients were associated with the patent ductus arteriosus(PDA), 22 cases with patent foramen ovale (PFO), 32 cases with atrial septal defect (ASD), 13 cases with ventricular septal defect (VSD), and 4 cases with double-chambered right ventricle.Radical corrections were performed in all patients under hypothermic general anaesthesia with cardiopulmonary bypass.There were 46 patients undergoing transannular patching with autologous pericardial flake and 28 patients undergoing transarterial pulmonary valvotomy. Results Urgent operations were performed in all patients and no death occurred during surgery.Median bypass time was 72 minutes(ranging from 40 to 100 minutes) and median aortic cross-clamp time was 43 minutes(ranging from 13 to 79 minutes). The time for the use of respirator was 4-128 h (median time was 15 h), and ICU stay lasted 4-18 days(median time was 5 days). Perioperative complications: included 1 case of ventricular fibrillation during operation, after electrical shock the patient returned to normal; postoperative complications included low cardiac output syndrome(4 cases), refractory hypoxemia(8 cases), acute renal failure(1 case), pneumothorax(2 cases), hydrothorax(2 cases), atelectasis(1 case). All patients received chest radiography, electrocardiogram and echocardiography during hospital stay.As a result, postoperative cardiac function was improved significantly. Conclusions Low cardiac output syndrome and hypoxemia aften exist in severe pulmonary stenosis.If severe pulmonary stenosis is diagnosed and operated early, the prognosis is good.The key to this kind of surgery is the application of autologous pericardium or disc pericardium patching for widening pulmonary artery appropriately, which fully rescind the right ventricular outflow tract obstruction.At the same time, the level of postoperative monitoring should be improved, and postoperative complications must be handled timely. Key words: Severe pulmonary valve stenosis; Cardiac surgical treatment; Congenital heart disease