HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ali Dodge-Khatami Ger B.W.E. Bennink Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Peterson, C. Articles by Bennink, G. B.W.E. Search for Related Content PubMed PubMed Citation Articles by Peterson, C. Articles by Bennink, G. B.W.E. Related Collections Congenital - acyanotic

Ann Thorac Surg 2003;76:1078-1083
© 2003 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children

^a Division of Cardiology, Utrecht, The Netherlands
^b Division of Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, The Netherlands

^* Address reprint requests to Dr Bennink, Wilhelmina Children’s Hospital, Division of Cardiothoracic Surgery, University of Utrecht, PO Box 18009, 3501 CA Utrecht, The Netherlands
e-mail: g.bennink{at}wkz.azu.nl

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

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.

This article has been cited by other articles:

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]

				T. M. Bashore Adult Congenital Heart Disease: Right Ventricular Outflow Tract Lesions Circulation, April 10, 2007; 115(14): 1933 - 1947. [Full Text] [PDF]

				J.W. Roos-Hesselink, F.J. Meijboom, S.E.C. Spitaels, R.T. vanDomburg, E.H.M. vanRijen, E.M.W.J. Utens, A.J.J.C. Bogers, and M.L. Simoons Long-term outcome after surgery for pulmonary stenosis (a longitudinal study of 22-33 years) Eur. Heart J., February 2, 2006; 27(4): 482 - 488. [Abstract] [Full Text] [PDF]

				M. G. Earing, H. M. Connolly, J. A. Dearani, N. M. Ammash, M. Grogan, and C. A. Warnes Long-term Follow-up of Patients After Surgical Treatment for Isolated Pulmonary Valve Stenosis Mayo Clin. Proc., July 1, 2005; 80(7): 871 - 876. [Abstract] [PDF]