INFUNDIBULAR RESECTION OR DILATATION FOR INFUNDIBULAR STENOSIS

Abstract

The authors report on their first 11 patients with infundibular stenosis as a part of Fallot''s tetralogy, who were subjected to infundibular resection or dilatation. Three who died were over 20 yrs. of age; the authors therefore believe that the operation should be avoided in older patients. Seven of the 8 who survived were greatly benefited. A special punch was used to resect the stenotic region. In 2 instances, only dilatation was needed because of the presence of a narrow fibrous ring. Within 2 months after operation, a slight increase in heart size occurred, which was not progressive. Ecg. changes during the operation consisted of changes in pacemaker and of the appearance of premature beats. A week after operation, cove-shaped S-T segment with T-wave inversion appeared in lead I with reciprocal changes in lead III. The changes progressed for about three weeks and then slowly regressed, disappearing after several months. No clinical changes were associated with these findings. Infundibular stenosis should be considered in Fallot''s tetralogy and in transposition of the great vessels. Angiocardiography can display a large infundibular chamber, best seen in the right anterior oblique position. Demonstration by cardiac catheterization of a sudden drop in pressure within the ventricles just below the valves is also diagnostic. If these findings are not demonstrated, differentiation from pulmonary stenosis can be made at operation when the heart and pulmonary artery are exposed after opening the pericardium.