Pulmonary valve stenosis surgery
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Differentiating Pulmonary valve stenosis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Surgery
Post Surgical Complications
After surgical valvotomy, beware the patients of following complications that can develop in next >20 years are
- Arrythmias
- Right ventricle enlargement
- Tricuspid regurgitation
- Pulmonary regurgitation
2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]
Indications for Balloon Valvotomy Adolescents (DO NOT EDIT) [1]
| Class I |
| "1. Balloon valvotomy is recommended in adolescent and young adult patients with pulmonic stenosis who have exertional dyspnea, angina, syncope, or presyncope and an RV–to–pulmonary artery peak-to-peak gradient greater than 30 mm Hg at catheterization. (Level of Evidence: C)" |
| "2. Balloon valvotomy is recommended in asymptomatic adolescent and young adult patients with pulmonic stenosis and RV–to–pulmonary artery peak-to-peak gradient greater than 40 mm Hg at catheterization. (Level of Evidence: C)" |
| Class III |
| "1. Balloon valvotomy is not recommended in asymptomatic adolescent and young adult patients with pulmonic stenosis and RV–to–pulmonary artery peak-to-peak gradient less than 30 mm Hg at catheterization. (Level of Evidence: C)" |
| Class IIb |
| "1. Balloon valvotomy may be reasonable in asymptomatic adolescent and young adult patients with pulmonic stenosis and an RV–to–pulmonary artery peak-to-peak gradient 30 to 39 mm Hg at catheterization. (Level of Evidence: C)" |
2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease (DO NOT EDIT) [2]
Recommendations for Intervention (DO NOT EDIT) [2]
| Class I |
| "1. Balloon valvotomy is recommended for asymptomatic patients with a domed pulmonary valve and a peak instantaneous Doppler gradient greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg (in association with less than moderate pulmonary valve regurgitation).(Level of Evidence: B) " |
| "2. Balloon valvotomy is recommended for symptomatic patients with a domed pulmonary valve and a peak instantaneous Doppler gradient greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg (in association with less than moderate pulmonary regurgitation).(Level of Evidence: C) " |
| "3. Surgical therapy is recommended for patients with severe PS and an associated hypoplastic pulmonary annulus, severe pulmonary regurgitation, subvalvular PS, or supravalvular PS. Surgery is also preferred for most dysplastic pulmonary valves and when there is associated severe TR or the need for a surgical Maze procedure.(Level of Evidence: C) " |
| "4. Surgeons with training and expertise in CHD should perform operations for the RVOT and pulmonary valve.(Level of Evidence: B) " |
| Class III |
| "1. Balloon valvotomy is not recommended for asymptomatic patients with a peak instantaneous gradient by Doppler less than 50 mm Hg in the presence of normal cardiac output.(Level of Evidence: C) " |
| "2. Balloon valvotomy is not recommended for symptomatic patients with PS and severe pulmonary regurgitation.(Level of Evidence: C) " |
| "3. Balloon valvotomy is not recommended for symptomatic patients with a peak instantaneous gradient by Doppler less than 30 mm Hg.(Level of Evidence: C) " |
| Class IIb |
| "1. Balloon valvotomy may be reasonable in asymptomatic patients with a dysplastic pulmonary valve and a peak instantaneous gradient by Doppler greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg.(Level of Evidence: C) " |
| "2. Balloon valvotomy may be reasonable in selected symptomatic patients with a dysplastic pulmonary valve and peak instantaneous gradient by Doppler greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg.(Level of Evidence: C) " |
Recommendation for Clinical Evaluation and Follow-up after Intervention (DO NOT EDIT) [2]
| Class I |
| "1. Periodic clinical follow-up is recommended for all patients after surgical or balloon pulmonary valvotomy, with specific attention given to the degree of pulmonary regurgitation; RV pressure, size, and function; and TR. The frequency of follow-up should be determined by the severity of hemodynamic abnormalities but should be at least every 5 years.(Level of Evidence: C) " |
Sources
- 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [1]
- 2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease - Recommendation for clinical evaluation and follow-up after intervention [2]
References
- ↑ 1.0 1.1 1.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 2.3 Warnes CA, Williams RG, Bashore TM; et al. (2008). "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. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677. Unknown parameter
|month=ignored (help)