Right ventricular outflow tract obstruction general management

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Right ventricular outflow tract obstruction Microchapters

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Patient Information

Overview

Anatomy of Pulmonary Valve

Classification

Pulmonary valve stenosis
Pulmonary subvalvular stenosis
Pulmonary supravalvular stenosis
Pulmonary atresia

Pathophysiology

Causes

Differentiating Right ventricular outflow tract obstruction from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac Catheterization

Pulmonary Angiography

Treatment

Indications For Surgery

Surgery

Pre-Operative A/P

Post-Operative A/P

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Special Scenarios

Pulmonary artery conduits/Prosthetic Valves

Double-Chambered Right Ventricle

Case Studies

Case #1

Right ventricular outflow tract obstruction general management On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3]

General Management

General Management


3. in patients with severe stenoses, there is impaired exercise tolerance and changes in the RV myocardium.

4. Surgery is indicated in patients with fatigability, DOE, cyanosis or CHF.

5. Surgery is recommended in the absence of symptoms if the gradient is greater than 75 mm Hg, and is also preferred if the gradient is as low as 50 to 60 mm Hg.

6. For those with gradients less than 50 mm Hg, then follow-up is recommended.

7. Long-term results of pulmonary valvuloplasty are not yet available, but short term results appear to be excellent.

a) Restenosis is likely is the residual gradient is greater than 30 mm Hg.

b) 79% of these patients have residual pulmonic regurgitation.

c) Following these procedures there is a soft residual systolic murmur, a diastolic murmur of pulmonic insufficiency, and some regression of the EKG criteria of RVH.

References

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