Isolated Valvular Pulmonic Stenosis

Abstract

Surgical correction of isolated valvular pulmonic stenosis was effected almost exclusively by the transventricular approach. The hemodynamic studies following this procedure reveal inadequate relief of the stenosis, and lack of uniformity of results. The advent of open heart surgery afforded by hypothermia has now permitted direct vision of the stenotic pulmonic valve from the arterial side. This communication presents pre- and postoperative clinical and physiologic evaluation of 10 patients with isolated valvular pulmonic stenosis. In 5 patients the approach to the valve was through the wall of the right ventricle, while in the remaining 5 patients the approach was through the pulmonary arterial wall. Although subjective improvement was descr. in patients in both groups, such an evaluation of results of surgery is not considered to represent a critical analysis of the success of this operation. The physiologic studies obtained in the group in which the valve was approached through the ventricle were variable, and in no instance was there evidence of complete removal of the valvular obstruction. The physiologic data detd. following the transarterial approach to the stenotic valve revealed uniformly good results. The right ventricular systolic pressure was reduced to normal levels in all 5 patients, and the pulmonary arterial pulse contour assumed a normal form in each instance. There was obliteration of the preoperative systolic pressure gradient from the right ventricle to the pulmonary artery in every patient. Thus, in this group complete relief of valvular obstruction was demonstrated, in contrast to the variable and inadequate relief of obstruction when the valve was approached via the right ventricle. The transarterial approach therefore, is recommended as the method of choice in the surgical therapy of isolated valvular pulmonic stenosis.