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Article: Evolving management for critical pulmonary stenosis in neonates and young infants

TitleEvolving management for critical pulmonary stenosis in neonates and young infants
Authors
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
Citation
Cardiology 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.
Persistent Identifierhttp://hdl.handle.net/10722/42427
ISSN
2014 Impact Factor: 0.835
2014 SCImago Journal Rankings: 0.454
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, YFen_HK
dc.contributor.authorLeung, MPen_HK
dc.contributor.authorLee, JWTen_HK
dc.contributor.authorChau, AKTen_HK
dc.contributor.authorYung, TCen_HK
dc.date.accessioned2007-01-29T08:49:43Z-
dc.date.available2007-01-29T08:49:43Z-
dc.date.issued2000en_HK
dc.identifier.citationCardiology In The Young, 2000, v. 10 n. 3, p. 186-192en_HK
dc.identifier.issn1047-9511en_HK
dc.identifier.urihttp://hdl.handle.net/10722/42427-
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.en_HK
dc.format.extent1157158 bytes-
dc.format.extent3357 bytes-
dc.format.extent4482 bytes-
dc.format.mimetypeapplication/pdf-
dc.format.mimetypetext/plain-
dc.format.mimetypetext/plain-
dc.languageengen_HK
dc.publisherCambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=CTYen_HK
dc.relation.ispartofCardiology in the Youngen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsCardiology in the Young. Copyright © Cambridge University Press.en_HK
dc.subjectCritical pulmonary stenosisen_HK
dc.subjectEvolving managementen_HK
dc.subject.meshCardiac surgical procedures - methods - mortalityen_HK
dc.subject.meshCineangiographyen_HK
dc.subject.meshMultivariate analysisen_HK
dc.subject.meshPulmonary valve stenosis - mortality - radiography - surgeryen_HK
dc.subject.meshVentricular outflow obstruction - mortality - radiography - surgeryen_HK
dc.titleEvolving management for critical pulmonary stenosis in neonates and young infantsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1047-9511&volume=10&spage=186&epage=192&date=2000&atitle=Evolving+management+for+critical+pulmonary+stenosis+in+neonates+and+young+infantsen_HK
dc.identifier.emailCheung, YF:xfcheung@hku.hken_HK
dc.identifier.authorityCheung, YF=rp00382en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.pmid10824897-
dc.identifier.scopuseid_2-s2.0-0034185156en_HK
dc.identifier.hkuros48618-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034185156&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume10en_HK
dc.identifier.issue3en_HK
dc.identifier.spage186en_HK
dc.identifier.epage192en_HK
dc.identifier.isiWOS:000086998800003-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridCheung, YF=7202111067en_HK
dc.identifier.scopusauthoridLeung, MP=7201944800en_HK
dc.identifier.scopusauthoridLee, JWT=7601458010en_HK
dc.identifier.scopusauthoridChau, AKT=35787094400en_HK
dc.identifier.scopusauthoridYung, TC=9132842300en_HK

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