Exercise Hemodynamics of Pulmonary Valvular Stenosis

Moller, James H.; Rao, Satyanarayana; Lucas, Russell V.

doi:10.1161/01.cir.46.5.1018

Cited by 33 publications

(4 citation statements)

References 9 publications

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“…In patients with pulmonary stenosis studied postoperatively, a similar variability was observed (Finnegan et al, 1974;Stone et al, 1974). Another study of patients with pulmonary stenosis showed that in the presence of mild stenosis the stroke volume increased on exercise but when the stenosis was more severe the stroke volume remained constant (Moller, Rao, and Lucas, 1972). In our study the changes in stroke volume during exercise were also variable.…”

Section: Pulmonary Valvular Regurgitationsupporting

confidence: 84%

Results of total correction of the tetralogy of Fallot. Long-term haemodynamic evaluation at rest and during exercise.

Finnegan¹,

Haider²,

Patel³

et al. 1976

Heart

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Postoperative haemodynamic evaluation was performed on 15 patients 7 to 14 years (mean, 11 years) after total intracardiac repair of Fallot's tetralogy. The average age of the patients at the time of postoperative catheterization was 20 years (range 12 to 29) and they were all asymptomatic. Before operation 11 patients were severely cyanosed and disabled and 4 had mild cyanosis with anoxic spells. The cardiac output and right heart pressures were measured at rest and after 5 minutes of submaximal exercise on a bicycle ergometer. It was shown that the degree of residual obstruction of the pulmonary outflow tract was slight and that the right ventricular/pulmonary arterial systolic gradient (RV/PA gradient) exceeded 20 mmHg (2-6 kPa) at rest in only 3 patients. The mean cardiac index at rest was 5-4 l min-1 m-2 which increased to 8-3 l min-1 m-2 during exercise. The response of the cardiac output during exercise was either normal or supranormal in 14 of the 15 patients. In the remaining patient the response was marginally below the normal range. Pulmonary valvular regurgitation was present in 8 patients but there was no detectable difference in the cardiac function of these patients compared with patients with competent pulmonary valves. Six of the patients investigated had also had cardiac catheterizations performed 1 to 4 years after operation. The results of the present study show that remarkably little change has occurred in their haemodynamic status in the intervening years. Though these results are encouraging, further studies are required to determine the eventual outcome of the RV pressure and volume overload.

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Section: Pulmonary Valvular Regurgitationsupporting

confidence: 84%

Results of total correction of the tetralogy of Fallot. Long-term haemodynamic evaluation at rest and during exercise.

Finnegan¹,

Haider²,

Patel³

et al. 1976

Heart

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“…Of greater concern than diastolic RV dysfunctionwhich appears to be reversible if PS is successfully corrected-is the RV structure that may be markedly hypoplastic if PS is critical-to-complete: while such hypoplastic ventricles may have considerable long-term growth potential when the continuity between the RV cavity and PA is established [32], BPV can do more immediate harm than good if an additional temporary source of auxiliary pulmonary blood flow is not established (as RV at times tends to collapse after decompression) [33]. It has also been shown that in much older subjects with a very tight PS (having pulmonary valvular area of less than 0.5 cm2/m2), RV fibrosis-indicative of permanent myocardial damage-sometimes occurs [34]. It is therefore clearly very important to assess precisely the detailed fundamentals of RV performance in patients who may not benefit from BPV because of their profound underlying RV abnormalities; this task is currently much easier than it was even a few years ago as the accurate assessment of RV function has grown to be quite sophisticated [35].…”

Section: Discussionmentioning

confidence: 99%

Management of typical and dysplastic pulmonic stenosis, uncomplicated or associated with complex intracardiac defects, in juveniles and adults: Use of percutaneous balloon pulmonary valvuloplasty with eight‐month hemodynamic follow‐up

David

Goussous

et al. 1993

Cathet. Cardiovasc. Diagn.

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To alleviate large fixed right ventricular (RV) outflow gradients, percutaneous balloon dilatation of pulmonic stenosis (PS) was performed in 38 patients with mean age of 14 +/- 14 years (median: 9 years, age range: 9 months to 63 years). There were 21 males and 17 females. Thirty-four patients had typical PS (5 of them also having other complex congenital cardiac anomalies, while 13 additional patients had a patent foramen ovale); 2 further subjects had subpulmonic, and 2 dysplastic pulmonary valvular obstructions. Sixteen patients were in the New York Heart Association (NYHA) Class I, 15 in Class II, 6 in Class III, and 1 in Class IV. Electrocardiographic (ECG) evidence of right ventricular hypertrophy (RVH) was present in 29 patients (76%); 3 patients had right bundle branch block (RBBB). For the entire group, there was a marked decrease in the mean systolic transpulmonic gradient in the immediate post-valvuloplasty period (from 97 +/- 43 to 26 +/- 17 mmHg; P < 0.0001). One patient expired 8 hours post-valvuloplasty (he was in the NYHA Class IV, and had severe RV failure). No other cardiovascular complications were encountered; the median hospital stay was 3 days (range: 1-10 days). At an 8-month follow-up, 12 patients who were reevaluated invasively had a median transpulmonic gradient of 27 mmHg (range: 5-92 mmHg) as compared to their pre-valvuloplasty values of 84 mmHg (range: 49-142 mmHg; P < 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Auf der Grundlage dieser insgesamt sehr guten, in den letzten Jahren allgemein noch verbesserten Operationsresultate sollte heute die Operationsindikation sicherlich breiter gestellt werden, um so mehr, als man davon ausgehen muß, daß die natürliche Entwicklung einer langjährigen Pulmonalstenose (vielleicht mit Ausschluß der leichten Schweregrade) neben myokardialer Hypertrophie zur Fibrose im rechten Ventrikel führt (20,24,23). Die Zunahme der infundibulären Pulmonalstenosen in unserem Krankengut bei zunehmendem Alter geben zur Vermutung Anlaß, daß die Hypertrophie der rechtsventrikulären Ausflußbahn selbst Ursache der infundibulären Stenose sein könnte.…”

Section: Discussionunclassified

Ergebnisse der operativen Behandlung von infundibulären und valvulären Pulmonalstenosen mit intaktem Ventrikelseptum

Meyer¹,

Bütterich²,

Mehmel³

et al. 1976

Thorac cardiovasc Surg

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Es werden 95 zwischen 1961 und 1971 am Kantons spital Zürich operierte Fälle mit kongenitaler Pulmonalstenose analysiert. Bei über 2/3 der Patienten han delte es sich um eine reine valvuläre Pulmonalstenose. Das mittlere Alter zum Zeitpunkt der Operation be trug 15 1/2 Jahre. Bei über der Hälfte der Fälle han delte es sich um eine schwere Pulmonalstenose (rechtsventrikulärer systolischer Druck über 100 mm Hg). Infundibuläre Stenosen wurden häufiger mit zuneh mendem Alter und steigendem hämodynamischem Schweregrad, was die Vermutung nahelegt, daß die zunehmende rechtsventrikuläre Hypertrophie für die infundibuläre Stenose mitverantwortlich ist. In der Regel nehmen die subjektiven Beschwerden mit hö herem Schweregrad der Pulmonalstenosen zu. Eine bedeutende Anzahl der Patienten mit mittelschweren und auch schweren Pulmonalstenosen war jedoch be schwerdefrei.

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Exercise Hemodynamics of Pulmonary Valvular Stenosis

Cited by 33 publications

References 9 publications

Results of total correction of the tetralogy of Fallot. Long-term haemodynamic evaluation at rest and during exercise.

Results of total correction of the tetralogy of Fallot. Long-term haemodynamic evaluation at rest and during exercise.

Management of typical and dysplastic pulmonic stenosis, uncomplicated or associated with complex intracardiac defects, in juveniles and adults: Use of percutaneous balloon pulmonary valvuloplasty with eight‐month hemodynamic follow‐up

Ergebnisse der operativen Behandlung von infundibulären und valvulären Pulmonalstenosen mit intaktem Ventrikelseptum

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