Regression after Open Valvotomy of Infundibular Stenosis Accompanying Severe Valvular Pulmonic Stenosis

Engle, Mary Allen; Holswade, George R.; Goldberg, Henry P.; Lukas, Daniel S.; Glenn, Frank

doi:10.1161/01.cir.17.5.862

Cited by 83 publications

(12 citation statements)

References 9 publications

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“…When carried out it only weakens the right ventricle without relieving the obstruction which is due to total hypertrophy of this chamber. We agree with Engle, Holswade, Goldberg, Lukas, and Glenn (1958) that in time the hypertrophy regresses.…”

Section: Discussionsupporting

confidence: 89%

Severe pulmonary stenosis in infancy and early childhood

Anderson

Nouri-Moghaddam

1969

Thorax

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Twenty-six patients in infancy and early childhood with severe pulmonary valve stenosis and intact ventricular septum are reviewed. They were selected from a larger series of 112 patients with pulmonary stenosis of any degree, on account of early onset of symptoms and the severity of the stenosis proven by cardiac catheterization and angiocardiography, at operation or at necropsy. Our criteria for severity in this series were: presence of symptoms within the first two years of life; right ventricular and right atrial hypertrophy on electrocardiography; and right ventricular pressure equal to or higher than systemic blood pressure. The warning signs prompting valvotomy are deterioration of the following features: cyanosis and dyspnoea; congestive cardiac failure; tricuspid incompetence; cardiac enlargement and pulmonary oligaemia on radiograph; and right ventricular and right atrial hypertrophy on electrocardiography. The lives of 13 patients were saved by timely valvotomy. These patients are all well six months to six years after operation. Five patients died before any operation could be performed. Eight patients died within 48 hours of operation. Had some of these patients been operated on earlier the evidence indicates that they would have had a better prognosis. Therefore the importance of early recognition, prompt treatment, and emergency valvotomy, if necessary, is emphasized.Severe pulmonary stenosis with intact ventricular septum and normal aortic root is a much graver condition in the first two years of life than in the older age group. In infancy and early childhood this disease is fatal unless promptly diagnosed and treated by pulmonary valvotomy. Insufficient general appreciation of this condition, despite a few reviews since 1952 (Johnson and Johnson, 1952; Gibson, White, Johnson, and Potts, 1954;Mustard, Rowe, and Firor, 1960;Mustard, Jain, and Trusler, 1968;Luke, 1966;Gersony, Bernhard, Nadas, and Gross, 1967) We are discussing only the early severe group in detail because only in this group did fatalities occur. Of the late severe group 18 patients have undergone successful elective pulmonary valvotomy and are well; a further two patients await operation. There have been many reviews of pulmonary stenosis in this older age group (Brock,

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Section: Discussionsupporting

confidence: 89%

Severe pulmonary stenosis in infancy and early childhood

Anderson

Nouri-Moghaddam

1969

Thorax

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“…After the initial experimental documentation of the anatomical reversibility of pressure (Patton et al, 1943) and volume (Drury, 1944) overload-induced hypertrophy, similar descriptions based on experimental and clinical observations (Hall et al, 1953;Engle et al, 1958;Beznak et al, 1969) have appeared. Our previous study of this subject demonstrated for the first time that, not only is full structural reversal of pressure overload-induced hypertrophy possible, but, also, there is a concomitant return of the functional abnormalities associated with this cardiac muscle state to normal.…”

mentioning

confidence: 82%

Complete reversibility of cat right ventricular chronic progressive pressure overload.

th¹,

Ta²

1984

Circulation Research

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SUMMARY. Chronic, progressive pressure overload of the cat right ventricle produces persistent, ongoing abnormalities of contractile, energetic, and biochemical function in vitro at a time when in vivo pump function is still normal. The present study tested the reversibility of the in vitro changes in this clinically relevant hypertrophy model. Fourteen sham-operated and 14 reversal cats were studied. After banding the animals as 1-kg kittens, right ventricular pressures were normal. Before band removal (25.2 ± 0.5 weeks later for the control group and 25.5 ± 0.3 weeks later for the hypertrophy reversal group), systolic right ventricular pressures were 24 ± 1 mm Hg for controls and 71 ± 5 mm Hg for the hypertrophy reversal group (P < 0.05). At study, 19.5 ± 1.1 weeks after a second sham operation for controls or 18.7 ± 0.7 weeks after band removal for the hypertrophy reversal group, these pressures were 24 ± 1 mm Hg for controls and 23 ± 1 mm Hg for the hypertrophy reversal group (P = NS); cardiac output was 0.18 ± 0.01 liters/kg per min for controls and 0.19 ± 0.01 liters/kg per min for the hypertrophy reversal group (P = NS). The ratio of right ventricle to body weight was normal in both groups, as was the right ventricular papillary muscle myocyte cross-sectional area and the myocardial collagen concentration. A right ventricular papillary muscle from each cat was studied at 29°C in a polarographic myograph. Preloaded shortening velocity was 0.79 ± 0.04 muscle lengths/sec for controls and 0.86 ± 0.03 muscle lengths/sec for the hypertrophy reversal group (P = NS); extent of shortening was 0.15 ± 0.01 muscle lengths for controls and 0.16 ± 0.01 muscle lengths for the hypertrophy reversal group (P = NS). At optimum isometric length, active tension was 59.7 ± 3 1 mN/mm for controls and 57.0 ±1.9 mN/mm 2 for the hypertrophy reversal group (P = NS); resting tension was 15.6 ±1.2 mN/mm 2 for controls and 13.6 ±1.6 mN/mm 2 for the hypertrophy reversal group (P = NS). Active and resting oxygen consumption levels did not differ in the two groups. This study demonstrates that-in the compensated stage of chronic, progressive pressure overload of the cat right ventricle-the contractile, energetic, and biochemical abnormalities of the hypertrophied myocardium are fully reversible. (Circ Res 54: 323-331, 1984)

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“…Long-term effects It is usually stated that the hypertrophied infundibulum eventually involutes if patients survive the immediate post-operative period (Engle, Holswade, Goldberg, Lukas, and Glenn, 1958), but Campbell (1959) showed that complete regression of the electrocardiogram was unlikely over the age of 20, if infundibular hypertrophy was severe, and and Johnson (1959) reported persistently raised right ventricular pressures even years after complete valvotomies. Brock (1961) found that the incidence of incomplete resolution was 22% in patients left Hg.…”

Section: -8mentioning

confidence: 99%

Pulmonary valve stenosis without ventricular septal defect: results of surgery.

Braimbridge¹,

Oakley²,

Bentall³

et al. 1966

Thorax

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It is 18 years since the first successful pulmonary valvotomies were carried out by Sellors (1948) and Brock (1948) in patients with the tetralogy of Fallot, and little less since Brock applied the closed transventricular technique to the treatment of pulmonary valve stenosis without ventricular septal defect. It is nevertheless probably true to say that no other cardiac condition is treated in so many different ways at the present time, due to ignorance of the natural prognosis of mild and moderate pulmonary valve stenosis and to the varying emphasis placed on four important facets of the problem: these are the small but unsatisfactory mortality of most current procedures; the desirability or otherwise of resection of hypertrophic infundibular muscle; the importance of closure of a foramen ovale and its relation to post-operative cyanosis; and the short-and longterm effects of any pulmonary incompetence which may be produced. Few authorities agree on the significance of these problems. The factors responsible for post-operative cyanosis have already been considered (Oakley, Braimbridge, Bentall, and Cleland, 1964).

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Regression after Open Valvotomy of Infundibular Stenosis Accompanying Severe Valvular Pulmonic Stenosis

Cited by 83 publications

References 9 publications

Severe pulmonary stenosis in infancy and early childhood

Severe pulmonary stenosis in infancy and early childhood

Complete reversibility of cat right ventricular chronic progressive pressure overload.

Pulmonary valve stenosis without ventricular septal defect: results of surgery.

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