title: Management of neonatal critical pulmonic stenosis in the balloon valvotomy era.
abstract: We evaluated our recent experience with management of neonatal critical pulmonic stenosis and intact ventricular septum between 1982 and 1988. Thirty-nine patients (aged less than 3 months) were treated initially by operation (group A, n = 19) or with balloon pulmonary valvotomy (group B, n = 20). Patients in group A were younger (5 +/- 1.3 versus 18 +/- 4 days in group B) (mean +/- standard error of the mean) and had a greater degree of hypoxia (oxygen tension, 55 +/- 4 versus 80 +/- 6 mm Hg) (p less than 0.05 for all variables). Ten patients in group A and 8 patients in group B had right ventricular hypoplasia, based on an angiographically determined index. Balloon pulmonary valvotomy was attempted in 20 patients at the time of the initial catheterization but was unsuccessful in 9 owing to inability to catheterize the hypoplastic right ventricular outflow tract (n = 8) and to recurrent infundibular stenosis (n = 1). Patients with failed balloon valvotomy were subsequently operated on within 24 hours. The early operative mortality (less than 30 days) was 25% (7 of 28); one death (9%) occurred after successful balloon valvotomy owing to associated critical aortic stenosis. The early postoperative gradient was 20 +/- 2 mm Hg; the post-balloon valvotomy gradient was 18 +/- 3 mm Hg. We conclude that balloon pulmonary valvotomy yields good results in patients with critical pulmonary stenosis with essentially normal-sized right ventricle, whereas surgical pulmonary valvotomy is required for patients with right ventricular hypoplasia.
authors.affiliation: Department of Surgery and Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Caspi
authors.forename: J G
authors.initials: JG
authors.lastname: Coles
authors.forename: L N
authors.initials: LN
authors.lastname: Benson
authors.forename: R M
authors.initials: RM
authors.lastname: Freedom
authors.forename: P E
authors.initials: PE
authors.lastname: Burrows
authors.forename: J F
authors.initials: JF
authors.lastname: Smallhorn
authors.forename: G A
authors.initials: GA
authors.lastname: Trusler
authors.forename: W G
authors.initials: WG
authors.lastname: Williams
mesh_terms: D001794:Blood Pressure; D002404:Catheterization / Q000379:methods*; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000002:abnormalities / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D011664:Pulmonary Valve / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D014262:Tricuspid Valve Insufficiency / Q000628:therapy