Document Detail


Surgical management of critical pulmonary stenosis in the neonate.
MedLine Citation:
PMID:  6541896     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Experience with 36 consecutive neonates less than 1 month of age with critical pulmonary stenosis (PS) with intact ventricular septum was analyzed to define the role of pulmonary valvotomy and of a concomitant systemic-pulmonary shunt as well as the impact of prostaglandin E1 (PGE1) therapy in the management of this disorder. Operative procedures included pulmonary valvotomy as an isolated procedure (Group 1, N = 22), pulmonary valvotomy plus a systemic-pulmonary shunt (Group 2, N = 8), pulmonary valvotomy with PGE1 therapy (Group 3, N = 5), and one miscellaneous procedure. The hospital mortality (+/- 70% confidence limits [CL]) by treatment group was as follows: Group 1, 54% (CL, 41-67%) (12/22); Group 2, 25% (CL, 9-50%) (2/8); and Group 3, 0 (CL, 0-32%); Group 1 versus Group 2 plus Group 3 (p less than or equal to 0.05). Patients managed with a shunt or perioperative administration of PGE1 experienced a significant improvement in early survival. Late postoperative angiography demonstrated exemplary right ventricular growth in the majority of patients, although important residual abnormalities of the outflow tract necessitating operative repair were frequently present (5-year and 10-year actuarial freedom from reoperation, 73 +/- 10% and 42 +/- 16%, respectively [+/- standard error of the mean]). This review illustrates the limitations of pulmonary valvotomy as an isolated therapeutic method in neonates with critical PS. Provision of a systemic extracardiac source of pulmonary blood flow, accomplished by a systemic-pulmonary shunt or PGE1 infusion continued postoperatively, is the most important determinant of early survival in this disorder.
Authors:
J G Coles; R M Freedom; P M Olley; F Coceani; W G Williams; G A Trusler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  38     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1984 Nov 
Date Detail:
Created Date:  1984-12-18     Completed Date:  1984-12-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  458-65     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Alprostadil
Blood Vessel Prosthesis
Cineangiography
Critical Care
Follow-Up Studies
Heart Septum
Hemodynamics
Humans
Infant, Newborn
Intraoperative Care
Methods
Prostaglandins E / therapeutic use
Pulmonary Artery / surgery
Pulmonary Valve / surgery
Pulmonary Valve Stenosis / diagnosis,  mortality,  surgery*
Reoperation
Chemical
Reg. No./Substance:
0/Prostaglandins E; 745-65-3/Alprostadil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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