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Article: Evolving management for critical pulmonary stenosis in neonates and young infants
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TitleEvolving management for critical pulmonary stenosis in neonates and young infants
 
AuthorsCheung, YF1
Leung, MP1 2
Lee, JWT1
Chau, AKT1
Yung, TC1
 
KeywordsCritical pulmonary stenosis
Evolving management
 
Issue Date2000
 
PublisherCambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=CTY
 
CitationCardiology In The Young, 2000, v. 10 n. 3, p. 186-192 [How to Cite?]
 
AbstractOver 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. © Greenwich Medical Media Ltd.
 
ISSN1047-9511
2013 Impact Factor: 0.857
 
ISI Accession Number IDWOS:000086998800003
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorCheung, YF
 
dc.contributor.authorLeung, MP
 
dc.contributor.authorLee, JWT
 
dc.contributor.authorChau, AKT
 
dc.contributor.authorYung, TC
 
dc.date.accessioned2007-01-29T08:49:43Z
 
dc.date.available2007-01-29T08:49:43Z
 
dc.date.issued2000
 
dc.description.abstractOver 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. © Greenwich Medical Media Ltd.
 
dc.description.naturepublished_or_final_version
 
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dc.format.extent4482 bytes
 
dc.format.mimetypeapplication/pdf
 
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dc.identifier.citationCardiology In The Young, 2000, v. 10 n. 3, p. 186-192 [How to Cite?]
 
dc.identifier.epage192
 
dc.identifier.hkuros48618
 
dc.identifier.isiWOS:000086998800003
 
dc.identifier.issn1047-9511
2013 Impact Factor: 0.857
 
dc.identifier.issue3
 
dc.identifier.openurl
 
dc.identifier.pmid10824897
 
dc.identifier.scopuseid_2-s2.0-0034185156
 
dc.identifier.spage186
 
dc.identifier.urihttp://hdl.handle.net/10722/42427
 
dc.identifier.volume10
 
dc.languageeng
 
dc.publisherCambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=CTY
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofCardiology in the Young
 
dc.relation.referencesReferences in Scopus
 
dc.rightsCardiology in the Young. Copyright © Cambridge University Press.
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshCardiac surgical procedures - methods - mortality
 
dc.subject.meshCineangiography
 
dc.subject.meshMultivariate analysis
 
dc.subject.meshPulmonary valve stenosis - mortality - radiography - surgery
 
dc.subject.meshVentricular outflow obstruction - mortality - radiography - surgery
 
dc.subjectCritical pulmonary stenosis
 
dc.subjectEvolving management
 
dc.titleEvolving management for critical pulmonary stenosis in neonates and young infants
 
dc.typeArticle
 
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Author Affiliations
  1. The University of Hong Kong
  2. Grantham Hospital Hong Kong