Surgical Management of Critical Pulmonary Stenosis in the Neonate

Coles, John G.; Freedom, Robert M.; Olley, Peter M.; Coceani, Flavio; Williams, William G.; Trusler, George A.

doi:10.1016/s0003-4975(10)64184-7

Cited by 32 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Critical VPS in the neonate has been treated surgically until recent years. In contrast to older children, mortality rates, however, have been higher, ranging from 0 to 57% (mean 29), using different procedures 1 [17][18][19][20][21][22][23][24]. However, in a recent series of 101 consecutive babies from 1987 to 1991, Hanley et al [22] noted that although the mortality among all 62 undergoing an outflow procedure using a variety of techniques was 22.6%, surgical valvotomy with cardiopulmonary bypass or open with inflow stasis was without mortality.…”

Section: Discussion Early Mortalitymentioning

confidence: 99%

See 1 more Smart Citation

Balloon dilation of critical valvar pulmonary stenosis in the first month of life

Colli

Perry

Lock

et al. 1995

Cathet. Cardiovasc. Diagn.

View full text Add to dashboard Cite

Between 1985 and 1992, 36 consecutive neonates, aged 1-29 days, weight 2.4-5.0 kg, with critical valvar pulmonary stenosis underwent attempted balloon dilation (BD). At catheterization, 30 were on prostaglandin (PGE1) therapy and 20 were intubated. The valve was successfully crossed and dilated in 34/36 (94%), including three with an echocardiographic diagnosis of valvar pulmonary atresia and a right ventricle of adequate size. The valve was first dilated with a 2- to 5-mm balloon and then with serially larger ones (up to 12 mm) to a final balloon/annulus value of 126%. The RV/systemic pressure value fell from 150 +/- 32 to 83 +/- 30%, O2 saturation rose from 91 +/- 6% to 96 +/- 4%, and PGE1 was discontinued at the end of the procedure. There were 11 complications (31%) including one early death from sepsis and necrotizing enterocolitis, endocarditis in another, two myocardial perforations, one femoral-iliac vein tear, and one transient pulse loss. A repeat BD was carried out in five patients, two of whom subsequently had surgery. At follow-up (33 +/- 23 months), the 31 patients managed by BD alone were well and had echocardiographic gradients of < 30 mm Hg in 90% and pulmonary regurgitation, considered mild in most, in 52%. In neonates with critical valvar pulmonary stenosis, we believe BD mortality is less than with surgery and is the treatment of choice.

show abstract

Section: Discussion Early Mortalitymentioning

confidence: 99%

“…In surgical series in the past, this has been considered a risk factor by some 123,241 but not by others [17,19,21,22]. An increase in RV size postoperatively has been described and also following BD [8,11,14].…”

Section: Hypoplastic Rvmentioning

confidence: 99%

Balloon dilation of critical valvar pulmonary stenosis in the first month of life

Colli

Perry

Lock

et al. 1995

Cathet. Cardiovasc. Diagn.

View full text Add to dashboard Cite

show abstract

“…'0 Various surgical techniques including transarterial or transventricular pulmonary valvotomy or valvectomy, with either inflow occlusion or cardiopulmonary bypass, or a systemic-to-pulmonary artery shunt combined with a pulmonary valvotomy have been used. The surgical treatment, however, has been associated with an operative mortality of between 33% and 750.l1 12 Perioperative infusion of prostaglandin E, may improve the outcome after surgical operation." However, in the presence of a results show that balloon dilatation is an effective form of emergency treatment.…”

Section: Discussionmentioning

confidence: 99%

Balloon dilatation of critical stenosis of the pulmonary valve in neonates.

Ladusans

Qureshi

Parsons

et al. 1990

Heart

View full text Add to dashboard Cite

Percutaneous balloon dilatation was attempted in 15 consecutive neonates (mean age 7.3 (range 1-27) days and weight 3.2 (range 2.5-4.1) kg) with critical stenosis of the pulmonary valve. Dilatation was successful in 11 (73%) patients. The mean balloon to annulus ratio was 1.1 (range 0.6-1.77). The ratio of right ventricle to femoral artery systolic pressure decreased from a mean (1 SD) of 1.4 (0.32) before to 0.8 (0.24) after dilatation and the transvalvar gradient decreased from 81 (29.7) mm Hg before to 33 (27.7) mm Hg after dilatation. All four (27%) patients in whom dilatation was unsuccessful underwent surgical valvotomy. Complications of balloon dilatation occurred in three (20%) patients; these included retroperitoneal haematoma (one) and iliofemoral venous occlusion (two). In one (7%) patient severe hypoxia and hypotension developed when the valve was crossed with a guide wire and balloon catheter. Despite successful dilatation he died 7 days after the procedure. During a mean (1 SD) follow up of 2 (1.7) years, seven (64%) of the 11 patients remained free of important restenosis. One patient required repeat dilatation three weeks after the initial procedure. In three (27%) patients restenosis developed 4-9 months after dilatation and all three had surgical valvotomy. Of the four patients initially referred for surgery three required a second operation and one required balloon dilatation. Percutaneous balloon dilatation gave effective relief of critical pulmonary stenosis in most neonates but complications and restenosis requiring surgery were common.

show abstract

“…From reports early in the balloon valvuloplasty era and even later, the mortality rates from various forms of surgery to relieve severe RV outflow obstruction by closed or open valvotomy, with or without cardiopulmonary bypass, were considerably high. [8][9][10] In a more recent prospective multi-institutional report involving 101 babies with severe critical pulmonary stenosis, the mortality rate in 62 who underwent surgery using a variety of techniques was 22.6%, whereas the mortality rate among 34 who underwent balloon dilatation was 6%. 11 It is perhaps in the light of this experience and the rapid improvement in the results of balloon valvuloplasty that this procedure remains the preferred mode of treatment in many institutions.…”

Section: Discussionmentioning

confidence: 99%

Critical Pulmonary Stenosis in Infants and Neonates in the Era of Interventional Cardiology

Bilkis

Alwi

Samion

et al. 1999

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Between September 1992 and February 1998, 22 consecutive patients aged 4 to 90 days with critical valvular pulmonary stenosis underwent percutaneous transluminal balloon valvuloplasty. Sixteen were cyanosed and 7 required prostaglandin infusion. The pulmonary valve was successfully crossed in all patients. Progressive dilatation was used to attain a final balloon to valve ratio between 1.2 and 1.4. Mean right ventricular systolic pressure dropped from 109 ± 26 to 34 ± 1 mm Hg. Oxygen saturation increased from 84% ± 8% to 98% ± 2%. There were 5 complications including 1 death due to valvular damage, 1 hemopericardium requiring drainage and transfusion, significant blood loss during cannulation in 2 cases, and a fractured guidewire that was retrieved in another. Repeat valvuloplasty was performed in 2 patients. Two patients required surgery; one had a dysplastic pulmonary valve with persistent pulmonary stenosis and the other had a hypoplastic right ventricle. Of the 20 patients who had valvuloplasty alone, 17 (85%) remained well with a mean peak systolic Doppler gradient of 30 ± 26 mm Hg and no pulmonary regurgitation. We concluded that valvuloplasty is likely to be the only procedure necessary for the majority of infants and neonates with critical pulmonary stenosis. However, surgery is required in cases of dysplastic pulmonary valve or hypoplastic right ventricle.

show abstract

Surgical Management of Critical Pulmonary Stenosis in the Neonate

Cited by 32 publications

References 26 publications

Balloon dilation of critical valvar pulmonary stenosis in the first month of life

Balloon dilation of critical valvar pulmonary stenosis in the first month of life

Balloon dilatation of critical stenosis of the pulmonary valve in neonates.

Critical Pulmonary Stenosis in Infants and Neonates in the Era of Interventional Cardiology

Contact Info

Product

Resources

About