The Annals of Thoracic Surgery, Vol 39, 159-164, Copyright © 1985 by The Society of Thoracic Surgeons
Pulmonary stenosis in infants and young children
DB Polansky, EB Clark and DB Doty
Twenty-four patients less than 3 years old underwent operation for
pulmonary stenosis. Pulmonary dysplasia was diagnosed preoperatively in
only 4 patients; in 20 patients the lesion was categorized simply as
pulmonary stenosis. At operation, more severe valve deformities were often
present in patients less than 2 years of age. Preoperative evaluation did
not reveal the extent of the deformity in 7 additional patients. The
deformities included not only valvular dysplasia (thickened redundant valve
cusps) but also supravalvular and annular abnormalities. Relief of
obstruction was obtained only when all components of the obstructive
abnormality were relieved. Patch angioplasty of the right ventricular
outflow tract was necessary in 13 patients with complex morphology.
Valvotomy was effective only for pulmonary stenosis due to pure commissural
fusion. A spectrum of the morphology of pulmonary stenosis is recognized,
with more complex lesions than simple commissural fusion identified in
younger children. The more complex lesions may require more extensive
operations (outflow tract patch) to completely relieve the obstructive
pathological condition in the outflow tract.