Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-24T06:12:34.121Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgically treated pulmonary stenosis: over 50 years of follow-up

Published online by Cambridge University Press:  21 July 2015

Eva A. Nielsen Open the ORCID record for Eva A. Nielsen [Opens in a new window]  and
Vibeke E. Hjortdal
Eva A. Nielsen*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
*
Correspondence to: E. A. Nielsen, Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Tel: +457 845 3082; Fax: +457 845 3079; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Surgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.

The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.

Results

The total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.

Conclusion

Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.

Keywords

Pulmonary stenosisCHDsurgerysurvivaloutcome
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 860 - 866
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Brock, SR. The surgical treatment of pulmonary stenosis. Br Heart J 1961; 23: 337–356.Google Scholar
2. Sellors, TH. Surgery of pulmonary stenosis; a case in which the pulmonary valve was successfully divided. Lancet 1948; 1: 988.Google Scholar
3. Mirowski, M, Shah, KD, Neill, CA, Taussig, HB. Long-term (10 to 13 years) follow-up study after transventricular pulmonary valvulotomy for pulmonary stenosis with intact ventricular septum. Circulation 1963; 28: 906–914.Google Scholar
4. Tandon, R, Nadas, AS, Gross, RE. Results of open-heart surgery in patients with pulmonic stenosis and intact ventricular septum: a report of 108 cases. Circulation 1965; 31: 190–201.Google Scholar
5. Kan, JS. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary-valve stenosis. N Engl J Med 1982; 307: 540–542.Google Scholar
6. Rao, PS. Percutaneous balloon pulmonary valvuloplasty: state of the art. Catheter Cardiovasc Interv 2007; 69: 747–763.Google Scholar
7. Pedersen, CB. The Danish Civil Registration System. Scand J Public Health 2011; 39 (Suppl 7): 22–25.Google Scholar
8. Prineas, RJ, Crow, RS, Blackburn, H. The Minnesota Code Manual of Electrocardiographic Findings: Standards and Procedures for Measurement and Classification. John Wright, Littleton, MA, 1982: 122–125.Google Scholar
9. Fine, JP, Gray, RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94: 496–509.Google Scholar
10. Chaturvedi, RR, Redington, AN. Pulmonary regurgitation in congenital heart disease. Heart 2007; 93: 880–889.Google Scholar
11. Morris, CD, Menashe, VD. 25-year mortality after surgical repair of congenital heart defect in childhood. A population-based cohort study. JAMA 1991; 266: 3447–3452.Google Scholar
12. Kopecky, SL, Gersh, BJ, McGoon, MD, et al. Long-term outcome of patients undergoing surgical repair of isolated pulmonary valve stenosis. Follow-up at 20–30 years. Circulation 1988; 78 (5 Pt 1): 1150–1156.Google Scholar
13. McNamara, DG, Latson, LA. Long-term follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more. Am J Cardiol 1982; 50: 560–568.Google Scholar
14. O’Connor, BK, Beekman, RH, Lindauer, A, Rocchini, A. Intermediate-term outcome after pulmonary balloon valvuloplasty: comparison with a matched surgical control group. JACC 1992; 20: 169–173.Google Scholar
15. Peterson, C, Schilthuis, JJ, Dodge-Khatami, A, Hitchcock, JF, Meijboom, EJ, Bennink, GBWE. Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children. Ann Thorac Surg. 2003; 76: 1078–1082.Google Scholar
16. Voet, A, Rega, F, de Bruaene, AV, et al. Long-term outcome after treatment of isolated pulmonary valve stenosis. Int J Cardiol 2012; 156: 11–15.Google Scholar
17. Fawzy, ME, Hassan, W, Fadel, BM, et al. Long-term results (up to 17 years) of pulmonary balloon valvuloplasty in adults and its effects on concomitant severe infundibular stenosis and tricuspid regurgitation. Am Heart J 2007; 153: 433–438.Google Scholar
18. Harrild, DM, Powell, AJ, Trang, TX, et al. Long-term pulmonary regurgitation following balloon valvuloplasty for pulmonary stenosis risk factors and relationship to exercise capacity and ventricular volume and function. J Am Coll Cardiol 2010; 55: 1041–1047.Google Scholar
19. Merino-Ingelmo, R, Santos-de Soto, J, Coserria-Sánchez, F, Descalzo-Señoran, A, Valverde-Pérez, I. Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population. Rev Esp Cardiol (Engl Ed) 2014; 67: 374–379.Google Scholar
20. Earing, MG, Connolly, HM, Dearani, JA, Ammash, NM, Grogan, M, Warnes, CA. Long-term follow-up of patients after surgical treatment for isolated pulmonary valve stenosis. Mayo Clin Proc 2005; 80: 871–876.Google Scholar
21. Roos-Hesselink, JW, Meijboom, FJ, Spitaels, SEC, et al. Long-term outcome after surgery for pulmonary stenosis (a longitudinal study of 22–33 years). Eur Heart J 2006; 27: 482–488.Google Scholar
22. Kirklin, JK, Kirklin, JW, Blackstone, EH, Milano, A, Pacifico, AD. Effect of transannular patching on outcome after repair of tetralogy of Fallot. Ann Thorac Surg 1989; 48: 783–791.Google Scholar
23. Warnes, CA, Williams, RG, Bashore, TM, 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). Circulation 2008; 118: e714–e833.Google Scholar
24. Baumgartner, H, Bonhoeffer, P, De Groot, NMS, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2915–2957.Google Scholar
25. Anderson, RH, Baker, EJ, Penny, DJ, Redington, AN, Rigby, ML, Wernowsky, G. Tetralogy of Fallot with pulmonary stenosis. In Robert H. Anderson (ed.) Paediatric Cardiology. Elsevier Health Sciences, Philadelphia, 2009: 753–773.Google Scholar
26. David, TE. Surgical treatment of aortic valve disease. Nat Rev Cardiol 2013; 10: 375–386.Google Scholar