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Results for “PULMONARY VALVE STENOSIS”

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At least 433 records · Page 24Linked to original sources
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↗
PubMed1980

Non-invasive diagnosis of subpulmonary outflow tract obstruction.

We have studied the echocardiographic and phonocardiographic findings in 18 patients with obstruction to ventricular outflow at subpulmonary valve level. The aetiology was congenital in 13 patients, a result of hypertrophic cardiomyopathy in three, and infiltration of the right ventricular outflow tract by glycogen or lymphoma in the remaining two. Abnormal systolic motion of the pulmonary valve, fluttering, and early or midsystolic closure were seen in 16 of 17 patients in whom the cusps were visualised. Normal pulmonary valve motion was found in one patient with coexisting pulmonary valve stenosis. In congenital infundibular stenosis the delay of the pulmonary component of the second heart sound (P2) was related to the severity of the obstruction. A pulmonary ejection sound, defined as a high-frequency sound occurring at the moment of full pulmonary valve opening, was absent except in the patient with coexisting pulmonary valve stenosis. In hypertrophic cardiomyopathy with obstruction to the right ventricular outflow, the ejection systolic murmur was softer with inspiration, a finding that contrasts with the respiratory variation seen with fixed obstruction. Recognition of these abnormalities should allow an accurate non-invasive diagnosis to be made and permit assessment of severity when P2 can be recorded.

Adolescent↗
PubMed1987

[Percutaneous transluminal balloon valvuloplasty in the treatment of congenital valvular pulmonary stenoses in childhood].

Five children aged 2 to 6 years with isolated pulmonary valve stenosis underwent treatment by percutaneous transluminal balloon valvuloplasty. A peak systolic gradient between right ventricle and pulmonary artery (delta RV/PA) was reduced from 60.4 +/- 18.7 mm Hg to 21.7 +/- 12.6 mm Hg and the right ventricular pressure fell from 76.2 +/- 20.7 mm Hg to 43.0 +/- 16.4 mm Hg. There were no complications. Percutaneous transluminal balloon valvuloplasty is a safe method to treat isolated pulmonary valve stenosis. It benefits many patients over a long term period and may provide definitive treatment in some patients.

Angioplasty, Balloon↗
PubMed1985

Balloon valvuloplasty and angioplasty in congenital heart disease.

Balloon dilatation valvuloplasty was performed in 16 patients with pulmonary valve stenosis aged 10 days to 17 years. Gradients were reduced in all but two patients and were less than or equal to 20 mm Hg after the procedure in all but these two and one other. Unsatisfactory initial results in these three patients were attributed to the use of too small a balloon in one patient (gradient subsequently abolished at repeat valvuloplasty), to a dysplastic valve in a neonate, and to the fact that there had been a previous surgical valvotomy with scar tissue formation in one patient. The good result was retained in six of seven patients followed up at three to six months. In one the gradient, having been reduced from 60 to 18 mm Hg, had risen to 35 mm Hg. Repeat valvuloplasty was technically impossible in this patient, but in two others residual gradients of 24 and 22 mm Hg were reduced to 4 and 8 mm Hg respectively by repeat valvuloplasty. Balloon dilatation angioplasty was successful in dilating a severe stenosis at the lower limb of an atrial baffle (previous correction of complete transposition) and in dilating supravalvar stenosis of the pulmonary artery resulting from previous banding and debanding. Thus balloon pulmonary valvuloplasty, though still a new technique, appears to be the treatment of choice in patients with typical pulmonary stenosis and thin mobile valves. Patients with dysplastic valves may be less suitable candidates for the procedure. Balloon angioplasty is likely to have other applications, including the treatment of postoperative stenotic lesions.

Adolescent↗
PubMed1976

Pulmonary valvulotomy under inflow stasis for isolated pulmonary stenosis.

One hundred ten patients were operated upon between 1961 and 1972 for isolated pulmonary stenosis by the inflow stasis technique. Analysis of the preoperative and postoperative clinical and catheterization data define the role of inflow stasis as an acceptable method of pulmonary valvulotomy except in relieving stenosis due to a dysplastic pulmonary valve. Patient ages ranged from 2 days to 36 years. All underwent preoperative catheterization and 69 (63%) were restudied postoperatively. Mean preoperative and postoperative peak systolic gradients were 93 and 23 mm Hg, respectively. Mean valve areas before and after operation were 0.38 and 1.10 cm2/m2. Operative mortality was 3.6% (4 patients), and there was 1 late death. Two of the dead were children 2 and 9 days old, respectively. Four patients required reoperation for residual gradients; 2 had dysplastic pulmonary valves. The overall results were excellent or good in 78%, fair in 15%, and poor in 7%. Patients with dysplatic pulmonary valves were in the poor or fair group, and it is recommended that the inflow stasis technique not be used for this type of pulmonary stenosis. The excellent surgical exposure, adequate time for valvulotomy, low morbidity, and freedom from problems of cardiopulmonary bypass are reasons for continued use of this technique for treatment of selected patients with pulmonary valve stenosis.

Adolescent↗
PubMedDate not supplied

[SYSTOLIC MURMURS].

Explore the source record for details and available documents.

Adolescent↗
PubMed2006

Double balloon pulmonary valvuloplasty: multi-track system versus conventional technique.

OBJECTIVES: To evaluate whether double balloon pulmonary valvuloplasty (DBPV) with the Multi-Track system (MTS) may help to simplify the procedure. BACKGROUND: DBPV is usually required for patients with pulmonary valve stenosis with large annulus. However, it needs two venous accesses and can be technically demanding. METHODS: From 07/03, 20 consecutive patients (19 +/- 10 yrs) with typical pulmonary valve stenosis underwent DBPV using the MTS (G1). The results were compared with those achieved by conventional DBPV performed in a matched historical group of 28 patients (21 +/- 11 yrs; P = NS) (G2). RESULTS: MTS balloons were easily advanced through the skin and inflated across the valve. Similar results were observed in regards to residual gradients (12 +/- 11 vs 14 +/- 10 mm Hg; P = NS) and right ventricular to systemic pressures (0.35 +/- 0.22 vs 0.37 +/- 0.26; P = NS). Procedure and fluoroscopic times were significant lower in G1 (78 +/- 24 vs 126 +/- 28; 15 +/- 12 vs 25 +/- 8 min, respectively; both P < 0.001). There was no major complication. Median follow-up was 1.8 yr for G1 and 5 yr for G2 (P = 0.037). At the last visit, peak instantaneous gradient across the right ventricular outflow tract by echocardiography was a mean 22 +/- 10 mm Hg for G1 and 25 +/- 9 mm Hg for G2 (P = NS). No patient had severe pulmonary insufficiency or required reintervention. CONCLUSIONS: The use of the MTS helped to expedite the procedure providing satisfactory midterm clinical outcomes, similar to those observed with the conventional DBPV technique.

Adolescent↗
PubMed1987

The morphology of the right ventricular outflow tract after percutaneous pulmonary valvotomy: long term follow up.

Twenty nine patients (19 male, mean (SD) age 6.25 (0.5) years (range 0.16-15 years] with typical pulmonary valve stenosis were treated by balloon dilatation of the pulmonary valve. They were studied by echocardiography before the procedure, immediately after it, and at follow up (mean (SD) 10.2 (5.6) months, n = 18). The morphology of the pulmonary valve, the right ventricular-pulmonary artery gradient, and ratio of the systolic to diastolic endocardial dimensions (infundibular ratio) were examined. No patient had pulmonary regurgitation before the study. The valve gradient was significantly reduced (47%) from a mean (SD) of 72 (31) to 37 (23) mm Hg with no short term change in cardiac index after dilatation with a balloon with a mean (SD) diameter that was 118 (10.8)% of the valve annulus. The infundibular ratio was unchanged by the procedure (0.49 (0.11) (n = 21) before dilatation and 0.47 (0.14) (n = 16) after dilatation). In twenty seven patients the commissure of the pulmonary valve was seen to be torn after dilatation. Two patients with bicuspid valves had flail leaflets. Doppler examination at follow up showed mild pulmonary insufficiency in all 29 patients; the mean (SD) valve gradient (31 (+/- 21) mm Hg) at follow up was no different from the gradient found immediately after the procedure and infundibular ratio (0.58 (0.15) was not abnormal. These data indicate that commissural tears are the primary mechanism of valve disruption and demonstrate that the dynamic right ventricular outflow tract obstruction relaxes and gradient reduction persists at follow up.

Adolescent↗
PubMed1997

Progressive hydrocephalus in two members of a family with autosomal dominant Noonan phenotype.

We present a family with an autosomal dominant phenotype characterized by pulmonary valve stenosis, craniofacial dysplasia with marked hypertelorism and, as a variable feature, progressive hydrocephalus. This phenotype is manifested in four patients from three subsequent generations of a family, with expression ranging from mild pulmonary stenosis combined with slight but characteristic facial dysmorphism to severe cyanotic pulmonary valve stenosis with multiple malformations lethal in early childhood. We consider this to be an unusual variant of Noonan syndrome.

Adult↗
PubMed1996

[The Turner syndrome and cardiovascular changes].

Nineteen consecutive patients with Turner's syndrome and different karyotypes underwent full cardiological evaluation (physical examination, electrocardiogram, chest X-ray and echocardiogram). Congenital heart disease was found in 26%. Other cardiovascular pathologies (long QT syndrome or systemic hypertension) were found in two patients. When compared with the general population, a higher incidence was present for all types of congenital heart diseases observed. Among cardiac anomalies in Turner's patients, aortic malformations (aortic coarctation and bicuspid aorta) were the most frequent, followed by patent ductus arterious and pulmonary valve stenosis. We have observed that the most severe malformations were preferably found with the 45,X karyotype. Pulmonary valve stenosis was found in a mosaicism 45,X/46,XX case. No anomaly was found in patients with X isochromosome. The ring pattern was not found in our series.

Adolescent↗
PubMed1990

[Interventional catheterization in the treatment of congenital and acquired heart defects].

The treatment of heart defects by interventional catheterization started in 1982, when the first report on balloon dilatation of pulmonary valve stenosis was published. Similar techniques have since been extended to many other lesions. Presently, two types of catheter intervention have come into use. The first is dilatation of stenotic lesions by inflatable balloons: the main defects treated include pulmonary valve stenoses, aortic valve stenoses, coarctation of the aorta and peripheral pulmonary artery stenoses. Second, it is now possible to close defects and unwanted vessels, such as a persistent ductus arteriosus, with umbrella-like devices introduced through catheters. While balloon dilatation has clearly become the treatment of choice for pulmonary valve stenosis, other applications remain either controversial (e.g. balloon dilatation of coarctation) or experimental (e.g. closure of atrial or ventricular septal defects). Time will tell what is the exact role of interventional cardiology, keeping in mind that surgery provides excellent results with minimal morbidity and mortality in these lesions.

Cardiac Catheterization↗
PubMed1987

Use of a double balloon technique for percutaneous balloon pulmonary valvotomy in adults.

Percutaneous double balloon pulmonary valvotomy was performed on seven consecutive adult patients (mean age 26 years) with congenital pulmonary valve stenosis. The peak systolic transvalvar pressure gradient was significantly reduced from a mean (SD) of 104(30) to 24.3(6) mm Hg. This haemodynamic improvement was maintained at six week follow up. In six patients pulmonary infundibular spasm developed immediately after valvotomy; however, these patients showed considerable haemodynamic improvement at the six week follow up. During balloon inflation the heart rate did not fall below 60 beats/minute and the systemic aortic pressure was maintained above 90 mm Hg. Early results indicate that percutaneous double balloon valvotomy in adults is an effective treatment for isolated pulmonary valve stenosis. Theoretically the two balloons provide a venting area during inflation. This has the advantage of preventing bradycardia or systemic hypotension during prolonged balloon inflation.

Adolescent↗
PubMed1996

Left hilar mass in a 62-year-old man: severe pulmonary valvular stenosis with a poststenotic aneurysm.

We describe a patient who had a left hilar mass initially diagnosed as probable bronchogenic carcinoma. When a paradoxic arterial embolus led to further investigation, the hilar mass was found to be a poststenotic dilatation due to a severe pulmonary valve stenosis. Percutaneous balloon valvuloplasty of the pulmonary valve was successfully done, and the patient is well 2 years after the procedure.

Aneurysm↗