Does mild pulmonary stenosis progress during childhood? a study of its natural course

Abstract

SummaryBackground: Increase in the gradient in congenital pulmonary valvular stenosis during follow-up is a subject of controversy and could determine the need for treatment in pediatric patients.Hypothesis: It is postulated that a gradient < 50 mmHg shows a stable or decreasing tendency at follow-up for congenital pulmonary valvular stenosis.Methods: Thirty-five patients with pulmonary stenosis, isolated and not treated, were followed for 7 years (interquartilic rank 5.7 years) at 1.5-year intervals. Clinical and complementary tests (electrocardiogram, x-ray, Doppler echocardiogram) were undertaken. The gradient was measured by Doppler and by using the clinical formula derived from the New England Study (Ellison). The changes observed from the initial to the final consultation were analyzed by means of the Student's t-test, paired Wilcoxon, and Pearson correlation coefficient.Results: No significant changes were noted on symptoms or physical examination. Signs of cardiac enlargement diminished on both ECG (R wave in V1, p < 0.0001) and x-ray (cardiothoracic ratio, p < 0.0007), with a decreasing gradient trend during the follow-up period (p < 0.026) as well.Conclusions: The gradient trend confirms the stable nature of mild pulmonary stenosis. In our study, we found that patients aged >6 months, whose gradients were below 40 mmHg at the time of diagnosis, remained stable and required no treatment. Furthermore, the follow-up control and clinical man-

Medium-long term follow-up results of valvular pulmonary stenosis in Turkish children

“…Yurt dışında VPD doğal seyri ile ilgili birçok çalışma yapılmış olmakla birlikte ülkemizde bu konu ile ilgili geniş serili çalışmalar kısıtlıdır (2,3). Bu makalede VPD'lı hastaların doğal seyrinin, ekokardiyografi verileri ışığında irdelenmesi amaç-lanmıştır.…”

Estenose pulmonar valvar discreta: a possível cura espontânea na evolução natural do defeito

“…The knowledge of the natural history of pulmonary valve stenosis allows us to state that moderate and accentuated defects tend to undergo the intensifying of their effects 2,3 and the mild defects, their decrease [2][3][4][5][6][7][8][9][10][11][12][13] .…”

“…Most of the publications also mention a favorable evolution in pulmonary valve stenosis when they present a mild degree of severity [2][3][4][5][6][7][8][9][10][11][12][13] . Few of these 5,7 show an unfavorable evolution of the mild defect, due to the rapid worsening of the condition, similar to what is observed in more severe defects, mainly when exteriorizing occurs early in life.…”

“…On the other hand, when the defect has a mild impact, its natural history tends to be even more favorable [2][3][4][5][6][7][8][9][10][11][12][13] , although the "spontaneous cure" is a rare occurrence 8 .…”

Canine Animal as a Model in the Repercussion of Pulmonary Stenosis: Analysis by Two-Dimensional Echocardiography and Doppler Mode - Case Report

“…In humans, patients with moderate and severe congenital defects of the pulmonary artery tend to undergo with the increasing repercussion of the disease [3], while the discrete defects tend to decrease [4]. The average longevity of patients with this type of defect is relatively short, due to the appearance of adverse factors in the evolution, responsible for deterioration of ventricular function, mainly represented by hypertrophy, fibrosis and, consequently, heart failure and arrhythmias [5].…”