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Evolving management for critical pulmonary stenosis in neonates and young infants

Published online by Cambridge University Press:  19 August 2008

Yiu-fai Cheung ,
Maurice P. Leung ,
Jan W. T. Lee ,
Adolphus K. T. Chau  and
Tak-cheung Yung
Yiu-fai Cheung
Affiliation:
Departments of Paediatrics and SurgeryUniversity of Hong Kong, Hong Kong
Maurice P. Leung*
Affiliation:
Departments of Paediatrics and SurgeryUniversity of Hong Kong, Hong Kong
Jan W. T. Lee
Affiliation:
Divisions of Paediatric Cardiology and Cardiovascular Surgery, University of Hong Kong, Hong Kong
Adolphus K. T. Chau
Affiliation:
Departments of Paediatrics and SurgeryUniversity of Hong Kong, Hong Kong
Tak-cheung Yung
Affiliation:
Departments of Paediatrics and SurgeryUniversity of Hong Kong, Hong Kong
*
Professor Maurice P. Leung, Department of Paediatrics, Division of Paediatric Cardiology, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong. Tel: 852–25182629; Fax: 852–25539491
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Abstract

Over the years, management of critical pulmonary stenosis in young infants has evolved from surgical reconstruction of the right ventricular outflow tract and closed pulmonary valvotomy to transcatheter balloon valvoplasty. Our study aimed at evaluating how the changing policy for management had affected the immediate and long term outcomes of babies with this cardiac lesion. Interventions were made in 34 infants at a median age of 8.5 days (2–90 days). Reconstruction of the right ventricular outflow tract reconstruction was performed in 10 patients, closed pulmonary valvotomy in 13, and balloon valvoplasty in 11. Initial procedure-related mortality was 50%, 15% and 0% respectively. Multivariate analysis revealed transannular patching of the right ventricular outflow tract, and male sex, to be significant factors for death. For the 27 survivors, the ratio of right ventricular to systemic systolic pressure decreased from 1.6 ± 0.3 to 0.3 ± 0.2 after reconstruction of the outflow tract, 1.8 ± 0.5 to 0.8 ± 0.4 after closed valvotomy, and 1.8 ± 0.6 to 0.9 ± 0.3 after balloon valvoplasty. The decrease was significantly greater after patch reconstruction (p=0.025) that required no further reinterventions. The overall rate of reintervention for the survivors was 37% (10/27). The freedom from reintervention after closed valvotomy was 82%, 64% and 51% at 1, 5 and 10 years respectively. The figure remained at 78% at both 1 and 5 years (p=0.66) after balloon valvoplasty. The higher reintervention rate for closed valvotomy corresponded to the significantly greater residual gradient across the pulmonary valve noted on follow-up (p=0.01). Reinterventions included balloon dilation (n=6), reconstruction of the outflow tract (n=4), and 1 each of ligation of an arterial duct and systemic-pulmonary arterial shunting. The risk factor for reintervention was a hypoplastic right ventricle. In conclusion, transcatheter balloon valvoplasty appears to be the optimum initial approach in view of its low mortality, efficacy at relieving the obstruction, and low rate of reintervention.

Keywords

Critical pulmonary stenosisevolving management
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 3 , May 2000 , pp. 186 - 192
Copyright
Copyright © Cambridge University Press 2000

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