The incidence and significance of pulmonic regurgitation after pulmonary valvulotomy

Talbert, James L.; Morrow, Andrew G.; Collins, Nicholas; Gilbert, Joseph W.

doi:10.1016/0002-8703(63)90121-2

Cited by 30 publications

(3 citation statements)

References 17 publications

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“…The use of a nonvalved conduit between the right ventricle and pulmonary artery, and its effect on myocardial development and performance is equivocal. [30][31][32][33][34][35][36][37][38][39][40][41][42] Although initial effects of pulmonary insufficiency are well-tolerated, pulmonary insufficiency is probably not a benign lesion. ", 1*, 23,27,[43][44][45][46][47] Except for valve replacement, most intracardiac techniques to relieve valvular pulmonic stenosis cause some degree of valvular insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

et al. 1984

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Relief of right ventricular outflow obstruction with a valveless Dacron conduit from the right ventricle to pulmonary artery was accomplished in 12 normal dogs. The procedure involved the development of a surgical technique without cardiopulmonary bypass, hypothermia, and/or venous occlusion; the development of a ventricular coring instrument; the fabrication of a wire supported Dacron conduit; the development of a basketed insert cannula; and the creation of an experimental model of pulmonlc stenosis. Of the 12 dogs operated, two died intraoperatively, three died postoperatively, and seven were electively euthanlzed postoperatively. Relief of the right ventricular outflow obstruction was documented in all cases by a reduction in mean peak right ventricular pressure, improvement of mean arterial pressure, decrease in mean right atrial pressure, and an increase in mean pulmonary artery pressure. The pulmonary insufficiency created was considered a tolerable although not benign condition. The technique would be of particular value in dogs with severe right ventricular hypertrophy.BSTRUCTION OF THE RIGHT ventricular outflow 0 tract (pulmonic stenosis) may be supravalvular, * Meadox Cooley Graft Veri-soft, Meadox Medicals, Inc., Oakt " 5 minute" Epoxy, Devcon Cop.,

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Section: Discussionmentioning

confidence: 99%

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

et al. 1984

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“…Pulmonary incompetence is a common sequel of pulmonary valvotomy, but many authors believe that the haemodynamic consequences of this regurgitation are well tolerated (Talbert, Morrow, Collins, and Gilbert, 1963). In this paper we report a patient who had severe pulmonary incompetence after valvotomy and who failed to maintain her initial clinical improvement.…”

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confidence: 86%

Homograft replacement of the pulmonary valve.

Fuller¹,

Marchand²,

Zion³

et al. 1966

Thorax

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Pulmonary incompetence is a common sequel of pulmonary valvotomy, but many authors believe that the haemodynamic consequences of this regurgitation are well tolerated (Talbert, Morrow, Collins, and Gilbert, 1963). In this paper we report a patient who had severe pulmonary incompetence after valvotomy and who failed to maintain her initial clinical improvement. Because of the severe leak it was considered reasonable to correct the incompetence surgically. A homograft pulmonary valve was used, and we are unaware of any previous report of its use in man, though Ross, Cooper, and Brockenbrough (1961) de-scribed the experimental replacement of the pulmonary valve with a tricuspid semilunar prosthesis in dogs. CASE REPORTA 9-year-old white girl was seen in 1958. There was a history of sweating and listlessness during infancy. After the age of 1 year she began to tire easily, and at the age of 4 years cyanosis of the lips and nails was noted. She was breathless on moderate exertion.She was undersized for her age and weighed 53 lb. (24 kg.). Central and peripheral cyanosis was present. The pulse was regular and the blood-pressure was 104/70 mm. Hg. There was a left parasternal heave of right ventricular hypertrophy, but no thrill could be felt. On auscultation a loud coarse pulmonary ejection systolic murmur with a single second sound was heard. Femoral pulses were present. The liver was not palpable.Radiographs showed an increase in the transverse diameter of the heart with a cardiothoracic ratio of 55% and a prominent pulmonary artery segment. The right ventricle and right atrium were enlarged. The lung fields were under-vascularized (Fig. 1).The electrocardiogram (Fig. 2) showed right ventricular hypertrophy and strain.Cardiac catheterization was done under basal narcosis with rectal barbiturate and using local anaesthetic. The salient findings are listed in Table I.The diagnosis was 'valvular pulmonic stenosis with intact ventricular septum; small right-to-left shunt, probably via a patent foramen ovale'.In January 1959 open pulmonary valvotomy was performed under cardiopulmonary bypass using the disc oxygenator. The heart was arrested with potassium citrate. The pulmonary artery was opened and a cone-shaped pulmonary valve was encountered. No commissures were identifiable. The diaphragm was cut, converting it into a bicuspid valve with an estimated orifice diameter of 2-5 cm. A small patent foramen ovale was closed by direct suture.Convalescence was uneventful. Examination three weeks after operation revealed no cyanosis, and the systemic arterial pulse was collapsing in character. The blood-pressure was 120/60 mm. Hg. Jugular venous pressure was raised to the angle of the jaw due to tricuspid incompetence. The liver was not palpable. No adventitious sounds were audible in the lungs. On palpation of the precordium a systolic thrill under the left clavicle and a right ventricular left parasternal heave were felt. The first heart sound was loud. The pulmonary component of the second sound could not be heard. There w...

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“…After each dilatation, (beginning with 4 mm) the blood lost (5-8 ml) was replaced as a bolus. In three cases (6,7,12) manual cardiac massage for 30-40 minutes was necessary. Each of these patients, however, was well enough to be extubated at the end of the operation.…”

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confidence: 99%

Closed pulmonary valvotomy in infants under 6 months of age: report of 14 consecutive cases without mortality.

Milo¹,

Yellin²,

Smolinsky³

et al. 1980

Thorax

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The incidence and significance of pulmonic regurgitation after pulmonary valvulotomy

Cited by 30 publications

References 17 publications

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

Homograft replacement of the pulmonary valve.

Closed pulmonary valvotomy in infants under 6 months of age: report of 14 consecutive cases without mortality.

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