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Results for “PULMONARY VALVE STENOSIS”

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At least 415 records · Page 23Linked to original sources
PubMed1997

[Interventional treatment of heart valve diseases].

Percutaneous balloon valvuloplasty of stenoses has been introduced into medical practice in the late 70ies. Over the past decade, the method has evolved to a valid alternative to valve surgery in selected cases. Balloon valvuloplasty of isolated mitral stenosis is to date the therapy of choice and yields results comparable to those of surgery. It is even superior in only moderately diseased valves. However, the most frequent valve stenosis, that is aortic stenosis of the elderly, is not suitable for balloon dilatation. Dilatation of congenital aortic stenosis can be attempted if the valve is bicuspid or tricuspid. The recurrence rates for valvular stenoses after valvuloplasty are similar to those after surgical commissurotomy.

Aged↗
PubMed1998

Fate of the neopulmonary valve after the arterial switch operation in neonates.

OBJECTIVES: The purpose of this study was to determine the incidence, risk factors, and outcomes of acquired stenosis of the neopulmonary valve after the neonatal arterial switch operation. METHODS: Reviewed were the preoperative and follow-up echocardiograms from 136 of 288 patients undergoing the arterial switch operation for whom adequate studies were available. Pulmonary stenosis was defined as a thickened and doming pulmonary valve and a pressure gradient of 20 mm Hg or more. Transposition of the great arteries was present with intact ventricular septum in 91 patients, with a ventricular septal detect in 39, with an aortic coarctation in 5, and with double-outlet right ventricle in 1 patient. No patient had preoperative valvular abnormalities (i.e., a bicuspid valve). RESULTS: During a median follow-up of 18 months (range <1 to 90 months), 32 patients (24%) had the development of supravalvular pulmonary stenosis, 15 (11%) with associated pulmonary valve stenosis (group I). Kaplan-Meier estimates of freedom from any intervention were 94% (95% confidence interval, 90% to 99%) at 1 year and 79% (95% confidence interval, 64% to 94%) at 5 years. The valve anulus before the arterial switch operation was significantly larger (p < 0.03) in those in whom neopulmonary valve stenosis did not develop (group II) than it was in those in whom it did (group I). At follow-up, the pulmonary valve anulus had decreased significantly in diameter in group I (p < 0.0005) and had remained larger in group II (p = 0.06) compared with normal diameter. Group I patients had the development of significant pulmonary valve hypoplasia (p < 0.03) whereas group II patients continued to have significantly larger valves compared with normal size (p < 0.0001). CONCLUSIONS: Neopulmonary valve stenosis after the arterial switch operation is not uncommon and is associated with growth failure of the valve anulus often associated with supravalvular pulmonary stenosis.

Female↗
PubMed1998

[Catheter intervention for adult congenital heart diseases].

The efficacy of catheter intervention for adult congenital heart diseases was evaluated in 27 patients aged 20 to 52 years (mean age at catheterization 25 +/- 7 years) from 1986 to 1996. Four patients had pulmonary valve stenosis, four had aortic valve stenosis, three had coarctation of the aorta, 10 had pulmonary artery stenosis, four had cyanotic heart diseases and aorto-pulmonary collateral arteries, one had patent ductus arteriosus, and one had cyanotic heart disease and stenotic Blalock-Taussig shunt. Balloon dilation was successful in all patients with pulmonary valve stenosis, and follow-up evaluation (1-8 years) showed no restenosis in any patients. Balloon dilation was successful in all patients with aortic valve stenosis, and follow-up evaluation (0.5-5 years) showed transvalvular pressure gradient < 50 mmHg. Stenosis was relieved successfully in all patients with coarctation of the aorta, and follow-up evaluation showed no restenosis. Balloon dilation was successful in eight of 13 locations (62%) in patients with pulmonary artery stenosis. Coil embolization was successful in all patients with cyanotic heart diseases and aortopulmonary collateral arteries. In a patient with patent ductus arteriosus, two coils were placed in the ductus arteriosus but were retrieved because hemolysis was observed after the embolization. These data indicate that catheter intervention in young adults with congenital heart diseases is as effective as in children.

Adult↗
PubMed1988

[Percutaneous pulmonary valvuloplasty in adults. An immediate evaluation and follow-up of 3 cases].

The immediate and late results of percutaneous pulmonary valvuloplasty in three symptomatic adult patients (21, 38 and 45 years) with severe pulmonary valve stenosis are reported. The right ventricle-pulmonary artery gradient fell from 135 mmHg to 50 mmHg in patient n. 1, from 124 mmHg to 95 mmHg in patient n. 2 and from 132 mmHg to 27 mmHg in patient n. 3. Six months later a further hemodynamic study showed a further reduction in the gradient in patient n. 1 and n. 2 (28 and 33 mmHg). A year and half after of clinical follow-up symptomatic improvement is still present without any clinical or echo-Doppler signs of restenosis. In conclusion, percutaneous pulmonary valvuloplasty is a simple and safe procedure for severe pulmonary valve stenosis even in adults with immediate and long-term good results.

Adult↗
PubMedDate not supplied

Transcatheter treatment of pulmonary outflow tract obstruction: a review.

The role of transcatheter methods in the management of pulmonary outflow tract obstruction are discussed in this review. Balloon pulmonary valvuloplasty for relief of isolated pulmonary valve stenosis has been successfully used by many investigators and is the procedure of choice for the management of these lesions. Supravalvar pulmonic stenosis, if discrete, can be relieved by balloon dilatation. Cyanotic children with interatrial right-to-left shunts secondary to severe valvar pulmonary stenosis respond in a manner similar to that observed with isolated pulmonary valve stenosis. In these patients, balloon valvuloplasty is the treatment of choice and may be corrective in most patients. In patients with interventricular right-to-left shunting secondary to pulmonary outflow tract obstruction and in patients with narrowed BT shunts, balloon dilatation may be an effective palliative procedure in a substantial proportion of patients obviating the need for an initial or second palliative shunt. Balloon dilatation is recommended if the patient's size or cardiac anatomy make them unsuitable for safe total surgical correction. In patients with pulmonary atresia, either initial opening of the atretic pulmonary valve by laser or by surgery with subsequent balloon dilatation are potentially beneficial in reducing the total number of surgical procedures that these children are likely to require. However, further clinical trials are needed before their general use.

Adult↗
PubMedDate not supplied

Noonan syndrome with double-chambered right ventricle.

The association of Noonan syndrome and a double-chambered right ventricle has not been reported previously in the medical literature. We report two patients with Noonan syndrome associated with pulmonary valve stenosis and double-chambered right ventricle due to anomalous hypertrophied muscle bundles. Pulmonary valve stenosis was operated on. However, hypertrophied muscle bundles were not resected, as they caused no obstruction to blood passage. Postoperative follow-up examinations revealed no symptoms. In conclusion, in those with Noonan syndrome there may be anomalous muscle bundles in the right ventricular cavity. It may not be necessary to resect them if they do not obstruct the right ventricular outflow tract.

Adolescent↗
PubMed1989

Subaortic stenosis in childhood: frequency of associated anomalies and surgical options.

In a 4-year period from July 1984 to July 1988, 21 children required surgical treatment for subaortic stenosis. Age at operation ranged from 12 months to 17 years (mean, 7.3 +/- 4.8 years). Associated anomalies were common and occurred in 13 patients (62%), including aortic valve insufficiency (eight), and stenosis (two), mitral valve stenosis (two) and insufficiency (one), and pulmonary valve stenosis (two) and absent pulmonary valve syndrome (one). A ventricular septal defect was present in five patients, and coarctation and patent ductus arteriosus occurred in three patients each. One patient had a complete atrioventricular septal defect, and one had an aortopulmonary window. Six patients had 15 previous procedures. The left ventricular to aortic gradient ranged from 20 to 170 mm Hg (mean, 59 +/- 43 mm Hg). The operation consisted of a transaortic resection (17), transventricular septal defect resection (two), a modified Konno procedure or septoplasty with preservation of the aortic valve (one), and a combined aortoventriculoplasty with homograft reconstruction of the ascending aorta and coronary reimplantation (one). There were no early deaths. One patient required pacemaker insertion for heart block. Follow-up ranged from 1 to 48 months (mean, 26.4 +/- 11.6 months). There was one late death 2 years after operation in the child with the aortopulmonary window who had Heath Edwards Type IV changes on a lung biopsy specimen at the original operation. One patient required reoperation for a residual gradient of 34 mm Hg 1 year after resection. Three patients still have aortic insufficiency. No cases of iatrogenic aortic valve injury occurred. Patients with subaortic stenosis represent a heterogeneous group. Early resection and additional procedures can be performed with a low mortality rate and can eliminate aortic insufficiency in many cases.

Adolescent↗
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↗
PubMed1976

An interventricular septal defect, pulmonary stenosis and bicuspid pulmonary valve in a Welsh pony foal.

A 6 month Welsh pony filly with an interventricular septal defect in conjunction with a pulmonary stenosis due to a bicuspid pulmonary valve is described. The animal had poor exercise tolerance, a loud pansystolic murmur and a precordial thrill. Blood pressure and oxygen tension values obtained during cardiac catheterization suggested the diagnosis which was confirmed at autopsy.

Animals↗
PubMed1983

A case of congenital triple valve disease.

We report a case of congenital triple valve stenosis with dominant pulmonary valve disease, sparing the aortic valve, presenting at the age of 51 years with progressive shortness of breath and central cyanosis. At post mortem, no intracardiac right to left communication could be demonstrated.

Female↗
PubMedDate not supplied

Intermediate-term follow-up results of pulmonary balloon valvuloplasty in children.

Twenty-two patients (10 boys, 12 girls) with pulmonary valve stenosis whose mean age was 6.7 +/- 4.1 years (range 1 to 14 years) at time of the procedure underwent balloon dilatation angioplasty. All patients had isolated pulmonary valve stenosis with no associated cardiac anomalies, and their pulmonary valvular gradients were greater than 50 mmHg. Diagnostic catheterization and balloon valvuloplasty were performed during the same procedure. The mean peak systolic pressure gradient before balloon dilation of 95.8 +/- 29.5 mmHg (54-163 mmHg) was reduced to 30.2 +/- 15.8 mmHg (7-64 mmHg) after balloon dilation (p < 0.001). A linear relation was found between the predilation pressure gradient and the pressure gradient drop (r = 0,86; SE: 28.94) (y = 0.89x - 12.11). Following a successful valvuloplasty, the mean peak systolic pressure in the right ventricle decreased from 119.0 +/- 30.4 mmHg (71-184 mmHg) to 55.2 +/- 16.9 mmHg (29-97 mmHg) (p < 0.001). Continuous wave Doppler was used for follow-up. Pressure gradients were estimated in 14 patients between one and 29 months after the dilation 120 +/- 7.1 months). The mean follow-up gradient was 19.0 +/- 6.0 mmHg (11-32 mmHg). No important complication was noted in the immediate course or throughout the follow-up period, but four patients (28.6%) had minimal pulmonary insufficiency. In conclusion, these data confirm that balloon dilation in valvular pulmonary stenosis is safe and effective, and suggest that stenosis does not recur.

Adolescent↗
PubMed1975

Pulmonary edema following pulmonary valvulotomy.

A previously unreported combination of critical pulmonary valve stenosis and mitral stenosis is described. The initial clinical presentation was one of right ventricular failure that obscured the evidence of pulmonary venous hypertension. Following pulmonary valvulotomy, pulmonary edema ensued because of the increased pulmonary blood flow. The importance of urgent cardiac catheterization postoperatively following an operation that increases pulmonary blood flow is discussed.

Child↗
PubMedDate not supplied

Percutaneous pulmonary valvuloplasty.

At Guy's Hospital percutaneous pulmonary valvuloplasty has been performed in 30 children with pulmonary valve stenosis. In 24 cases the results were satisfactory. There was little change in the stenoses of six children; three of these were found to have dysplastic valves at surgery. One child had a valvuloplasty performed twice. Follow up in eight children has shown the long term success of the procedure with no complications. Before percutaneous pulmonary valvuloplasty was available the only treatment for pulmonary valvular stenosis was surgery. This entailed a lengthy stay in hospital, a long postoperative period and an unsightly midline chest scar. The average length of time spent in hospital for surgery is two weeks, and for valvuloplasty a few days. Percutaneous pulmonary valvuloplasty should be considered as the initial treatment of choice for most congenital pulmonary valve stenosis. It is safe, effective, can be performed at any age and can reduce the risks of surgery.

Cardiac Catheterization↗