Abstract
Twenty-six patients in infancy and early childhood with severe pulmonary valve stenosis and intact ventricular septum are reviewed. They were selected from a larger series of 112 patients with pulmonary stenosis of any degree, on account of early onset of symptoms and the severity of the stenosis proven by cardiac catheterization and angiocardiography, at operation or at necropsy. Our criteria for severity in this series were: presence of symptoms within the first two years of life; right ventricular and right atrial hypertrophy on electrocardiography; and right ventricular pressure equal to or higher than systemic blood pressure. The warning signs prompting valvotomy are deterioration of the following features: cyanosis and dyspnoea; congestive cardiac failure; tricuspid incompetence; cardiac enlargement and pulmonary oligaemia on radiograph; and right ventricular and right atrial hypertrophy on electrocardiography. The lives of 13 patients were saved by timely valvotomy. These patients are all well six months to six years after operation. Five patients died before any operation could be performed. Eight patients died within 48 hours of operation. Had some of these patients been operated on earlier the evidence indicates that they would have had a better prognosis. Therefore the importance of early recognition, prompt treatment, and emergency valvotomy, if necessary, is emphasized.
Full text
PDF














Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- ABRAHAMS D. G., WOOD P. Pulmonary stenosis with normal aortic root. Br Heart J. 1951 Oct;13(4):519–548. doi: 10.1136/hrt.13.4.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BENTON J. W., Jr, ELLIOTT L. P., ADAMS P., Jr, ANDERSON R. C., HONG C. Y., LESTER R. G. Pulmonary atresia and stenosis with intact ventricular septum. Am J Dis Child. 1962 Aug;104:161–168. doi: 10.1001/archpedi.1962.02080030163009. [DOI] [PubMed] [Google Scholar]
- BROCK R. C. Pulmonary valvulotomy for the relief of congenital pulmonary stenosis; report of three cases. Br Med J. 1948 Jun 12;1(4562):1121–1126. doi: 10.1136/bmj.1.4562.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BURACK W. R., PRYCE J., GOODWIN J. F. A reversible nephrotic syndrome associated with congestive heart failure. Circulation. 1958 Oct;18(4 Pt 1):562–571. doi: 10.1161/01.cir.18.4.562. [DOI] [PubMed] [Google Scholar]
- Berman G. D., Linde L. M., Mulder D. G. Staged repair of pulmonic stenosis and hypoplastic right ventricle. Arch Surg. 1965 Oct;91(4):597–601. doi: 10.1001/archsurg.1965.01320160051011. [DOI] [PubMed] [Google Scholar]
- Braimbridge M. V., Oakley C. M., Bentall H. H., Cleland W. P. Pulmonary valve stenosis without ventricular septal defect: results of surgery. Thorax. 1966 Mar;21(2):164–174. doi: 10.1136/thx.21.2.164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- CAYLER G. G., ONGLEY P., NADAS A. S. Relation of systolic pressure in the right ventricle to the electrocardiogram; a study of patients with pulmonary stenosis and intact ventricular septum. N Engl J Med. 1958 May 15;258(20):979–982. doi: 10.1056/NEJM195805152582003. [DOI] [PubMed] [Google Scholar]
- ENGLE M. A., HOLSWADE G. R., GOLDBERG H. P., LUKAS D. S., GLENN F. Regression after open valvotomy of infundibular stenosis accompanying severe valvular pulmonic stenosis. Circulation. 1958 May;17(5):862–873. doi: 10.1161/01.cir.17.5.862. [DOI] [PubMed] [Google Scholar]
- ENGLE M. A., ITO T., GOLDBERG H. P. THE FATE OF THE PATIENT WITH PULMONIC STENOSIS. Circulation. 1964 Oct;30:554–561. doi: 10.1161/01.cir.30.4.554. [DOI] [PubMed] [Google Scholar]
- Gersony W. M., Bernhard W. F., Nadas A. S., Gross R. E. Diagnosis and surgical treatment of infants with critical pulmonary outflow obstruction. Study of thirty-four infants with pulmonary stenosis or atresia, and intact ventricular septum. Circulation. 1967 Apr;35(4):765–776. doi: 10.1161/01.cir.35.4.765. [DOI] [PubMed] [Google Scholar]
- Hardy J. D., Timmis H. H., Webb W. R., Watson D. G., Blake T. M. Isolated pulmonic stenosis: surgical results in 26 cases. Surgery. 1966 Nov;60(5):980–985. [PubMed] [Google Scholar]
- JOHNSON R. P., JOHNSON E. E. Congenital pulmonic stenosis with open foramen ovale in infancy; report of five proved cases. Am Heart J. 1952 Sep;44(3):344–359. doi: 10.1016/0002-8703(52)90255-x. [DOI] [PubMed] [Google Scholar]
- LILLEHEI C. W., SIMMONS R. L., TODD D. B. LATE HEMODYNAMIC RESPONSE TO CORRECTION OF ISOLATED PULMONARY STENOSIS BY OPEN OPERATION DURING PULMONARY BYPASS. Circulation. 1965 Aug;32:258–264. doi: 10.1161/01.cir.32.2.258. [DOI] [PubMed] [Google Scholar]
- MUSTARD W. T., ROWE R. D., FIROR W. B., Jr Pulmonic stenosis in the first year of life: results of surgery. Surgery. 1960 Apr;47:678–684. [PubMed] [Google Scholar]
- Moller J. H., Adams P., Jr The natural history of pulmonary valvular stenosis. Serial cardiac catheterizations in 21 children. Am J Cardiol. 1965 Nov;16(5):654–664. doi: 10.1016/0002-9149(65)90048-2. [DOI] [PubMed] [Google Scholar]
- Mustard W. T., Jain S. C., Trusler G. A. Pulmonary stenosis in the first year of life. Br Heart J. 1968 Mar;30(2):255–257. doi: 10.1136/hrt.30.2.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
- TANDON R., NADAS A. S., GROSS R. E. RESULTS OF OPEN-HEART SURGERY IN PATIENTS WITH PULMONIC STENOSIS AND INTACT VENTRICULAR SEPTUM. A REPORT OF 108 CASES. Circulation. 1965 Feb;31:190–201. doi: 10.1161/01.cir.31.2.190. [DOI] [PubMed] [Google Scholar]
- THAYER J. M., GLECKLER W. J., HOLMES R. O. The development of the nephrotic syndrome during the course of congestive heart failure: case report and review of the literature. Ann Intern Med. 1961 May;54:1013–1025. doi: 10.7326/0003-4819-54-5-1013. [DOI] [PubMed] [Google Scholar]
- WILLIAMS J. C., BARRATT-BOYES B. G., LOWE J. B. Underdeveloped right ventricle and pulmonary stenosis. Am J Cardiol. 1963 Apr;11:458–468. doi: 10.1016/0002-9149(63)90005-5. [DOI] [PubMed] [Google Scholar]










