title: Surgical treatment of non-critical right ventricular outflow tract obstruction with intact ventricular septum in patients over one year of age.
abstract: Between March 1966 and May 1982, 257 patients with clinically noncritical right ventricular outflow tract obstruction with intact ventricular septum (RVOTO/IVS) underwent elective open-heart correction, with an overall early mortality of 3.9%. Age ranged from 13 months to 48 years (mean 6.6 +/- 6.5 - median 5). We describe three different anatomical types, for which a standardized surgical approach is suggested. When one or more of the following features--small right ventricular cavity; rigid infundibular stenosis; hypoplastic pulmonary annulus and trunk; dysplastic cusps--were present, the mortality (10.6%) was significantly higher than in isolated valvular stenosis (2.2%) or in valvular plus dynamic infundibular stenosis or isolated low-lying stenosis (2.5%). In a series of 159 consecutive patients operated upon since September 1974 the cumulative early mortality was 1.3%. Late results on 202 patients (mean follow-up period of 25.6 +/- 22.6 months) are good in 90.6% and fair in 8.9% of the cases. One patient died of encephalitis 2 years after the operation. We believe that a more precise characterization of the underlying lesions and a more liberal use of different surgical techniques to minimize residual gradients, iatrogenic pulmonary incompetence and impairment of right ventricular contractility, may decrease early mortality and improve overall results.
mesh_terms: D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007558:Italy; D011183:Postoperative Complications / Q000401:mortality