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At least 199 records · Page 11Linked to original sources
PubMed1995

Early balloon dilatation of the pulmonary valve in infants with tetralogy of Fallot. Risks and benefits.

BACKGROUND: Balloon dilatation, an established treatment for pulmonary valve stenosis, remains a controversial procedure in tetralogy of Fallot. METHODS AND RESULTS: Balloon dilatation of the pulmonary valve was performed in 19 infants with tetralogy of Fallot. Its effects on the severity of cyanosis, the growth of the pulmonary valve and pulmonary arteries, and the need for transannular patching were evaluated. Clinical, echographic, angiographic, hemodynamic, and operative data were analyzed. The procedure was safe in all, without significant complications. After balloon dilatation, systemic oxygen saturation increased from a mean value of 79% to 90%. This increase proved to be short-lasting in 4 patients, who required surgery before the age of 6 months. Balloon dilatation increased pulmonary annulus size in each case, from a mean value of 4.9 to 6.9 mm (P < .001). This gain in size remained stable over time, with a mean Z score of -4.8 SD before dilatation, -3.1 SD immediately after the procedure, and -2.7 SD at preoperative catheterization (P < .001). Pulmonary artery dimensions remained unchanged immediately after balloon dilatation but increased at follow-up from a Z score mean value of -2.5 to -0.06 SD and from -2.2 to 0.04 SD for right and left pulmonary arteries, respectively (P < .001). At the time of corrective surgery, the pulmonary annulus was considered large enough to avoid a transannular patch in 69% of the infants. This represented a 30% to 40% reduction in the need for a transannular patch compared with the incidence of transannular patch expected before balloon dilatation. CONCLUSIONS: Pulmonary valve dilatation in infants with tetralogy of Fallot is a relatively safe procedure and appears to produce adequate palliation in most patients. It allowed the growth of the pulmonary annulus and of the pulmonary arteries, resulting in a mean gain of 2 SD for those structures.

Cardiac Catheterization↗
PubMed1998

Results of three to 10 year follow up of balloon dilatation of the pulmonary valve.

BACKGROUND: The results of immediate and short term follow up of balloon dilatation of the pulmonary valve have been well documented, but there is limited information on long term follow up. OBJECTIVE: To evaluate the results of three to 10 year follow up of balloon dilatation of the pulmonary valve in children and adolescents. SETTING: Tertiary care centre/university hospital. DESIGN: Retrospective study. METHODS AND RESULTS: 85 patients (aged between 1 day and 20 years, mean (SD) 7.0 (6.4) years) underwent balloon dilatation of the pulmonary valve during an 11 year period ending August 1994. There was a resultant reduction in the peak to peak gradient from 87 (38) to 26 (22) mm Hg. Immediate surgical intervention was not required. Residual gradients of 29 (17) mm Hg were measured by catheterisation (n = 47) and echo Doppler (n = 82) at intermediate term follow up (two years). When individual results were scrutinised, nine of 82 patients had restenosis, defined as a peak gradient of 50 mm Hg or more. Seven of these patients underwent repeat balloon dilatation of the pulmonary valve: peak gradients were reduced from 89 (40) to 38 (20) mm Hg. Clinical evaluation and echo Doppler data of 80 patients showed that residual peak instantaneous Doppler gradients were 17 (15) mm Hg at long term follow up (three to 10 years, median seven), with evidence for late restenosis in one patient (1.3%). Surgical intervention was necessary to relieve fixed infundibular stenosis in three patients and supravalvar pulmonary stenosis in one. Repeat balloon dilatation was performed to relieve restenosis in two patients. Actuarial reintervention free rates at one, two, five, and 10 years were 94%, 89%, 88%, and 84%, respectively. Pulmonary valve regurgitation was noted in 70 of 80 patients at late follow up, but neither right ventricular dilatation nor paradoxical interventricular septal motion developed. CONCLUSIONS: The results of late follow up of balloon dilatation of the pulmonary valve are excellent. Repeat balloon dilatation was performed in 11% of patients and surgical intervention for subvalvlar or supravalvar stenosis in 5%. Most patients had mild residual pulmonary regurgitation but right ventricular volume overload was not required. Balloon dilatation is the treatment of choice in the management of moderate to severe stenosis of the pulmonary valve. Further follow up studies should be undertaken to evaluate the significance of residual pulmonary regurgitation.

Adolescent↗
PubMed2000

[Absent pulmonary valve syndrome with ductal origin of the left pulmonary artery. Diagnosis only by 2-D echo doppler color flow mapping].

A two-month old infant is described with the rare combination of absent pulmonary valve syndrome, ventricular septal defect, pulmonar "anular" stenosis and ductal origin of the left pulmonary artery. The diagnosis that was confirmed in the operating room was made by 2-D echocardiographic Doppler color flow mapping study without the support of cardiac catheterization.

Echocardiography, Doppler, Color↗
PubMed1993

[Quantification of postoperative pulmonary valve insufficiency: severity and clinical symptoms].

Surgical treatment of pulmonary stenosis may lead to inevitable valvular incompetence. The hemodynamic and clinical significance of post-operative pulmonary insufficiency (PI) is uncertain. In patients presenting cardiomegaly and reduced exercise tolerance reoperation may be considered. However, pulmonary valve replacement remains controversial. In order to elucidate the relevance of PI in the long-term post-operative course, quantitative data of PI were compared with chest radiographs and the physical condition. Thirty-one patients with a mean age of 18.5 years (3-36 years) were studied. Twenty-two patients had surgical correction of Tetralogy of Fallot (TOF) and nine had commissurotomy of pulmonary valve stenosis (PS). Catheterization was performed, on average, 12.9 years (2-29 years) after operation in 68% of cases with an interval of more than 10 years. PI was quantitated by digital roentgen densitometry. Regurgitant fraction (RGF) ranged between 13-61%, according to a right ventricle volume load index (VBI) of 1.15-2.6 (ratio of total to effective stroke volume). Twenty of 31 patients (12 TOF, 8 PS) had PI as the only significant lesion. VBI (1.15-2.6) correlated with the cardio thoracic ratio (0.50-0.64), r = 0.74. All patients were in good physical condition. 11 actively took part in sports: all of the eight patients studied by ergometry met normal conditions. Four patients had antiarrhythmic medication. Eleven of 31 patients had PI and additional abnormalities: tricuspid insufficiency (4), right ventricular pressure overload (5), ventricular septal defect (1), depressed left ventricular function (5), and aortic insufficiency (3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Papillary fibroelastoma of the pulmonary valve: assessment by live/real time three-dimensional transthoracic echocardiography.

The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambl's excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.00017-0.033% in autopsy series and 0.019% in clinical series identified on echocardiography. Although rare, fibroelastomas are the most common tumors affecting the cardiac valves with aortic, mitral, tricuspid, and pulmonary valves being involved in this order. In the current report we describe a case of pulmonary valve mass in which a confident prospective diagnosis of fibroelastoma could be made utilizing the technique of three-dimensional transthoracic echocardiography.

Adult↗
PubMed1989

[Prenatal diagnosis of severe tricuspid valve insufficiency in Ebstein anomaly with pulmonary valve atresia by 2-dimensional color coded Doppler echocardiography].

By the application of all methods of fetal echocardiography the prenatal diagnosis and a prognostically correct assessment was reached in a severe case of Ebstein's anomaly of tricuspid valve associated with pulmonary atresia, severe tricuspid regurgitation, and a hypoplastic main pulmonary artery. It is demonstrated that only the application of two-dimensional color-coded Doppler-echocardiography followed by a spectral-Doppler-echocardiography can result in an accurate evaluation of hemodynamical alterations and thus in the prognostic assessment in the reported case.

Adult↗
PubMed1991

[Initial primary sarcoma of the pulmonary valve and trunk of the pulmonary artery].

Primary sarcomas arising from the trunk or branches of the pulmonary artery are exceedingly rare and usually diagnosed at autopsy. The authors report the case of a 31 year old man referred for investigation of recurrent syncope. Echocardiography, right ventriculography and the thoracic computed tomography led to early diagnosis of a pulmonary artery tumour and surgical resection. Histology revealed a primary sarcoma. The early postoperative course was uncomplicated but one month after surgery a local recurrence was diagnosed at routine echocardiographic examination. The syncopal symptoms recurred seven months after surgery and echocardiography showed tumour recurrence on the interventricular septum and in the pulmonary artery. A second palliative operation was attempted but was unsuccessful because of the size of the tumour.

Adult↗
PubMed1998

Concomitant pulmonary valve replacement, VSD closure and coronary artery bypass surgery.

BACKGROUND AND AIMS OF THE STUDY: Although pulmonary valve stenosis may be treated by percutaneous balloon valvulotomy, surgery is preferred in adult patients with dysplastic valves. METHODS: Recently a 50-year-old man with isolated, calcific pulmonary stenosis and concomitant coronary artery disease was referred for surgery. Preoperatively, he suffered from dyspnea (NYHA class I-II) and angina pectoris (CCS class I-II). During catheterization a peak-to-peak gradient of 120 mmHg was measured across the pulmonary valve, while angiography revealed two-vessel coronary artery disease. RESULTS: During surgery, after opening the main pulmonary artery, an unsuspected small ventricular septal defect (VSD) and a severely calcified, altered pulmonary valve were detected. The VSD was closed and the valve replaced with a stentless bioprosthesis; concomitant double coronary artery bypass grafting was performed. The postoperative course was uneventful. CONCLUSIONS: Adult patients with pulmonary valve stenosis and concomitant coronary artery disease can be treated simultaneously by surgery with excellent results. Replacement devices may be homografts, or as in this patient, a stentless xenograft.

Bioprosthesis↗
PubMed1999

Percutaneous balloon valvuloplasty for congenital pulmonary valve stenosis in adults.

BACKGROUND: Although pulmonary valvular stenosis is not uncommon in adults, there are few reports of percutaneous pulmonary valvuloplasty in adults, despite the possibility of avoiding heart surgery. AIM: This report describes the experience in adult patients undergoing this procedure and evaluates its effectiveness and tolerance. METHODS: Over an 8-year period (1989-1997), pulmonary valvuloplasty was considered in 22 adult patients [8 men, 14 women; mean age 28.0 years +/- standard deviation (SD) 10.3; range 16-46 years] with congenital pulmonary valve stenosis. Sixteen patients were asymptomatic with pulmonary systolic murmurs, although 6 patients presented with dyspnea. Before the procedure, the mean transpulmonary valve gradient was 53.2 +/- 24.8 mmHg SD, with a mean right ventricular systolic pressure of 74.6 +/- 28.4 mmHg SD, and mean pulmonary artery pressure was 21.4 +/- 6.4/10.2 +/-3.9 mmHg. RESULTS: The procedure was successful in 19 patients (6 men, 13 women) and was well tolerated and free of complications. Following the procedure, the mean transvalvular gradient was 15.5 +/- 11.5 mmHg, with a mean right ventricular systolic pressure of 40.5 +/- 13.6 mmHg and a mean pulmonary systolic pressure of 24.3 +/- 7.4 mmHg. This represented mean fall in transpulmonary valve gradient of 42.4 +/- 22.0 mmHg (paired t-test, p < 0.0001). After a mean follow-up of 20.1 months (13.4 SD), most patients remained well and asymptomatic, although two patients required repeat valvuloplasty. CONCLUSION: Pulmonary valvuloplasty is a well tolerated and effective treatment for pulmonary valve stenosis in adults, with few complications and no need for surgery. This procedure should be considered as the primary treatment of adult patients with pulmonary valve stenosis.

Adolescent↗
PubMed2005

Late pulmonary valve implantation after repair of tetralogy of Fallot.

Ten cases of elective late pulmonary valve implantation after repair of tetralogy of Fallot were reviewed. The interval after initial repair ranged from 1.5 to 43 years (mean, 20.0 +/- 12.3 years). There was no hospital mortality or late death during a mean follow-up of 12.5 months. Preoperatively, 9 patients were in New York Heart Association functional class III-IV; after pulmonary valve implantation, all 10 patients were in class I-II (average improvement, 1.7 classes). Left ventricular ejection fraction improved significantly (from 62.1% +/- 4.7% to 70.2% +/- 4.9%), as did fractional shortening (from 34.0% +/- 5.0% to 40.0% +/- 4.2%). Right ventricular diameter decreased significantly (from 32.3 +/- 7.5 to 24.4 +/- 5.4 mm). QRS duration decreased significantly (155.2 +/- 27.1 vs. 140.0 +/- 21.2 msec), but there was no significant difference in QT interval (460.9 +/- 29.6 vs. 451.9 +/- 50.6 msec). Hospital stay was 4-7 days. One patient had preoperative ventricular fibrillation requiring resuscitation and an implantable cardiac defibrillator; another needed a defibrillator at the time of pulmonary valve implantation, because of ventricular arrhythmias. It was concluded that late pulmonary valve implantation after tetralogy of Fallot repair had significant benefits and carried low operative risk.

Adolescent↗
PubMed1995

Deletion within chromosome 22 is common in patients with absent pulmonary valve syndrome.

Interstitial deletions in chromosome 22 and features associated with CATCH-22 syndrome have been reported in patients with conotruncal congenital heart anomalies. Absent pulmonary valve syndrome is characterized by absent or rudimentary pulmonary valve cusps, absent ductus arteriosus, conoventricular septal defect, and massive dilation of the pulmonary arteries. Because absence of the ductus arteriosus is a key element in the pathogenesis of this syndrome and aortic arch malformations are frequently seen in patients with CATCH-22 syndrome, we hypothesized that patients with absent pulmonary valve syndrome would have a high incidence of deletions in the critical region of chromosome 22. Eight patients with absent pulmonary valve syndrome were studied. Metaphase preparations were examined with fluorescent in situ hybridization of the N25 (D22S75) probe to the critical region of chromosome 22q11.2. Deletions were detected in 6 of 8 patients. The presence of deletions in chromosome 22 in most of the patients we have examined with a diagnosis of absent pulmonary valve syndrome supports a specific genetic and embryologic mechanism involving the interaction of the neural crest and the primitive aortic arches as one cause of congenital absence of the pulmonary valve.

Chromosome Deletion↗