| Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children. | |
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MedLine Citation:
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PMID: 14529989 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for pulmonary valve stenosis in infants and children. METHODS: Results after surgical pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 +/- 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 +/- 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, pulmonary valve insufficiency, and tricuspid valve insufficiency were considered. RESULTS: Mean pressure gradient decreased significantly more in the surgical group (from 64.8 +/- 30.8 mm Hg to 12.8 +/- 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 +/- 21.4 mm Hg to 21.5 +/- 15.9 mm Hg after a mean of 5.4 years; p < 0.001). Moderate pulmonary valve insufficiency occurred in 44% after surgery, and in 11% after BV (p < 0.001). Tricuspid valve insufficiency occurred in 2% after surgery, and in 5% after BV. Restenosis occurred in 3 surgical patients (5.6%), 2 patients required reoperation, and 1 patient required a balloon valvotomy. Restenosis developed in 13 BV patients (14.1%): 6 patients were redilated and 7 patients required surgery. Surgical valvotomy led to significantly less reinterventions than balloon valvuloplasty (p < 0.04). CONCLUSIONS: Surgical relief of pulmonary valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated pulmonary valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed. |
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Authors:
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Claire Peterson; Johanneke J Schilthuis; Ali Dodge-Khatami; J Francois Hitchcock; Erik J Meijboom; Ger B W E Bennink |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 76 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2003 Oct |
Date Detail:
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Created Date: 2003-10-07 Completed Date: 2003-11-20 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1078-82; discussion 1082-3 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Balloon Dilatation* Child, Preschool Follow-Up Studies Heart Septal Defects, Atrial / complications Heart Septal Defects, Ventricular / complications Humans Infant Pulmonary Valve / surgery* Pulmonary Valve Stenosis / surgery* Recurrence Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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