The Natural History of Pulmonary Stenosis

Møller, Inge; Wennevold, A; Lyngborg, K

doi:10.1159/000169634

Cited by 15 publications

(6 citation statements)

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“…4,15 The average value of the gradient (Group 1, 33.5 mmHg; Group 2, 21.7 mmHg) placed our series in the mild range according to gradient. [4][5][6][11][12][13]20 Establishing whether or not PS is progressive is important because patients, particularly asymptomatic ones, are likely to be lost to follow-up as adults. Moreover, continued cardiac care into adulthood was not satisfactory; 40.5% had no evaluation after they were beyond pediatric age.…”

Section: Discussionmentioning

confidence: 99%

“…7 Surgical or balloon interventions may be indicated in patients with gradient ≥ 50 mmHg; nevertheless, the choice of management of patients with gradients < 50 mmHg remains debatable. 4,5,[9][10][11][12][13] In this study, we postulate that congenital pulmonary stenosis with mild gradients remains stable or decreases at follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…4,9,10 Therefore, the indication for treatment is based on valvular gradient. Pulmonary valvular stenosis is classified 5,[11][12][13] according to this gradient as trivial (≤ 20 mmHg), mild (21-40 mmHg), moderate (41-70 mmHg), and severe (> 70 mmHg).…”

Section: Introductionmentioning

confidence: 99%

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

Ardura¹,

González²,

Andres³

2004

Clinical Cardiology

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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-

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ardura¹,

González²,

Andres³

2004

Clinical Cardiology

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“…Other studies identified a sudden increase in DG in some children and adolescents (Møller et al . , Nugent et al . 1977, Lange et al .…”

Section: Discussionmentioning

confidence: 99%

Pulmonic stenosis in dogs: survival and risk factors in a retrospective cohort of patients

Locatelli

Spalla

Domenech³

et al. 2013

J of Small Animal Practice

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“…Regular follow-up and very early detection of changes is important. Even in mild or moderate disease very fast progression in infancy or early childhood has been documented 11)12). Patients with severe stenosis should undergo treatment even if it is well tolerated and is asymptomatic at the beginning, because of the possibility of dangerous complication 13)14)…”

Section: Discussionmentioning

confidence: 99%

The Comparison between the Echocardiographic Data to the Cardiac Catheterization Data on the Diagnosis, Treatment, and Follow-Up in Patients Diagnosed as Pulmonary Valve Stenosis

Kim

Park

Jung

et al. 2013

J Cardiovasc Ultrasound

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BackgroundIsolated pulmonary valve stenosis (PS) makes up 6-9% of all congenital heart defects among children. The initial gold standard for diagnosis, follow-up of PS is by echocardiography. However, the most accurate diagnosis still remains to be measurement of the pressure gradient through transcatheterization. The purpose of this study is to compare the difference between the echocardiographic data to the cardiac catheterization data on the diagnosis, treatment, and follow-up in patients diagnosed as PS, and to see what parameters should be closely monitored.MethodsA total of 112 patients (Male : Female = 46 : 66) who underwent balloon pulmonary valvuloplasty (BPV) at Severance Cardiovascular Hospital, between December, 2002 to August, 2012 were retrospectively analyzed. The patients were all under 16 years of age and critical PS patients who underwent BPV were excluded from this study.ResultsThe pre-BPV right ventricle (RV)-pulmonary artery (PA) systolic pressure gradient and post-BPV systolic pressure gradient showed statistically significant decrease. The pre-BPV RV-PA systolic pressure gradient and 3 month post-BPV systolic pressure gradient showed statistically significant decrease. The consistency between the echocardiographic data and cardiac catheterization data shows statistically significant consistency. The mean pressure gradient and systolic pressure gradient on the echocardiography shows high consistency when comparing with the cardiac catheterization data.ConclusionOur study shows that BPV in PS is a safe and effective procedure in children and adolescent. The standard echocardiographic evaluation of PS, during diagnosis and follow-up, should include mean transpulmonic pressure gradient, as well as the peak systolic pressure gradient. The success of the procedure should be held off until at least 3 months, only if the patients do not show any symptoms.

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The Natural History of Pulmonary Stenosis

Cited by 15 publications

References 5 publications

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

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

Pulmonic stenosis in dogs: survival and risk factors in a retrospective cohort of patients

The Comparison between the Echocardiographic Data to the Cardiac Catheterization Data on the Diagnosis, Treatment, and Follow-Up in Patients Diagnosed as Pulmonary Valve Stenosis

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