Article: Evolving management for critical pulmonary stenosis in neonates and young infants
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| Title | Evolving management for critical pulmonary stenosis in neonates and young infants |
|---|---|
| Authors | Cheung, YF1 Leung, MP1 2 Lee, JWT1 Chau, AKT1 Yung, TC1 |
| Keywords | Critical pulmonary stenosis Evolving management |
| Issue Date | 2000 |
| Publisher | Cambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=CTY |
| Citation | Cardiology In The Young, 2000, v. 10 n. 3, p. 186-192 [How to Cite?] |
| 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. © Greenwich Medical Media Ltd. |
| ISSN | 1047-9511 2011 Impact Factor: 0.759 2011 SCImago Journal Rankings: 0.089 |
| ISI Accession Number ID | WOS:000086998800003 |
| References | References in Scopus |
| dc.contributor.author | Cheung, YF |
|---|---|
| dc.contributor.author | Leung, MP |
| dc.contributor.author | Lee, JWT |
| dc.contributor.author | Chau, AKT |
| dc.contributor.author | Yung, TC |
| dc.date.accessioned | 2007-01-29T08:49:43Z |
| dc.date.available | 2007-01-29T08:49:43Z |
| dc.date.issued | 2000 |
| dc.description.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. © Greenwich Medical Media Ltd. |
| dc.description.nature | published_or_final_version |
| dc.format.extent | 1157158 bytes |
| dc.format.extent | 3357 bytes |
| dc.format.extent | 4482 bytes |
| dc.format.mimetype | application/pdf |
| dc.format.mimetype | text/plain |
| dc.format.mimetype | text/plain |
| dc.identifier.citation | Cardiology In The Young, 2000, v. 10 n. 3, p. 186-192 [How to Cite?] |
| dc.identifier.epage | 192 |
| dc.identifier.hkuros | 48618 |
| dc.identifier.isi | WOS:000086998800003 |
| dc.identifier.issn | 1047-9511 2011 Impact Factor: 0.759 2011 SCImago Journal Rankings: 0.089 |
| dc.identifier.issue | 3 |
| dc.identifier.openurl | |
| dc.identifier.pmid | 10824897 |
| dc.identifier.scopus | eid_2-s2.0-0034185156 |
| dc.identifier.spage | 186 |
| dc.identifier.uri | http://hdl.handle.net/10722/42427 |
| dc.identifier.volume | 10 |
| dc.language | eng |
| dc.publisher | Cambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=CTY |
| dc.publisher.place | United Kingdom |
| dc.relation.ispartof | Cardiology in the Young |
| dc.relation.references | References in Scopus |
| dc.rights | Cardiology in the Young. Copyright © Cambridge University Press. |
| dc.rights | Creative Commons: Attribution 3.0 Hong Kong License |
| dc.subject.mesh | Cardiac surgical procedures - methods - mortality |
| dc.subject.mesh | Cineangiography |
| dc.subject.mesh | Multivariate analysis |
| dc.subject.mesh | Pulmonary valve stenosis - mortality - radiography - surgery |
| dc.subject.mesh | Ventricular outflow obstruction - mortality - radiography - surgery |
| dc.subject | Critical pulmonary stenosis |
| dc.subject | Evolving management |
| dc.title | Evolving management for critical pulmonary stenosis in neonates and young infants |
| dc.type | Article |
Author Affiliations
- The University of Hong Kong
- Grantham Hospital Hong Kong