Regression of valvular pulmonary stenosis.

Abstract

Eight patients with mild to moderate valvular pulmonary stenosis underwent serial physiological studies before surgical intervention. Average pulnwnary valve area at the initial study was o 59 CM.2 and at the second study (average 7-8 serial studies were performed in 8 subjects with mild to moderate valvular pulmonary stenosis to determine how valve area changes with time. These changes are related to normal pulmonary valve growth. Materials and methodsEight patients with mild to moderate valvular pulmonary stenosis (5 male, 3 female) underwent serial cardiac evaluation without surgical intervention. Routine clinical studies included x-rays and electrocardiograms. Right heart catheterizations were performed in the usual manner and hydrogen curves were obtained in the pulmonary artery to exclude any coexistent left-to-right shunt (Vogel, Grover, and Blount, I962). Cardiac output was determined by the Fick method, and pulmonary valve area and pulmonary valve index were calculated using the method of Gorlin (I966). Normal valve areas were calculated from valve circumferences reported by Schulz and Giordano (I962). The valve index was determined from heights and weights obtained from the Children's Research Council.At the time of the initial study the patients ranged in age from 2 months to 28 years (average I0 years). The average interval between studies was 7-8 years (range 3-5 tO I0 years). ResultsPulmonary valve area The average pulmonary valve area at the time of the initial study was 0-59 cm.2 (range OI3 tO I-45) and at the time of the second study I -09 cm.2 (range 0-55-2-I2): an average increase of 0-49 Cm.2+±02I (p>0 05) (Table).In 7 of the 8 patients, pulmonary valve on 12 May 2018 by guest. Protected by copyright.

Estenose pulmonar valvar discreta: a possível cura espontânea na evolução natural do defeito

“…Wennevold and Jacobsen 2 observed worsening in 1 (14.2%) of 7 patients with pressure gradient < 50 mmHg. Lueker et al 12 observed a mild worsening in 1 (12.5%) of 8 patients with pressure gradient < 50 mmHg during a mean period of 7.8 years, in children. Nugent et al 9 had also noticed worsening of the pulmonary transvalvular gradient in 14% of the patients evaluated by a hemodynamic study, during a period of 4 to 8 years.…”

“…Most of the publications also mention a favorable evolution in pulmonary valve stenosis when they present a mild degree of severity [2][3][4][5][6][7][8][9][10][11][12][13] . Few of these 5,7 show an unfavorable evolution of the mild defect, due to the rapid worsening of the condition, similar to what is observed in more severe defects, mainly when exteriorizing occurs early in life.…”

“…The knowledge of the natural history of pulmonary valve stenosis allows us to state that moderate and accentuated defects tend to undergo the intensifying of their effects 2,3 and the mild defects, their decrease [2][3][4][5][6][7][8][9][10][11][12][13] .…”

“…On the other hand, when the defect has a mild impact, its natural history tends to be even more favorable [2][3][4][5][6][7][8][9][10][11][12][13] , although the "spontaneous cure" is a rare occurrence 8 .…”

Mild to Moderate Pulmonary Valvular Stenosis in Infant Sometimes Improves to the Condition Unnecessary to Do PTPV: Doppler Echocardiographic Observation.

“…The transpulmonary valve pressure gradient can be estimated from the peak V measured by Doppler echocardiography using a simplified Bernoulli's equation, which is, at present, regarded as the most reliable noninvasive methodology to evaluate the severity of PS (Hatle and Angelsen 1982; Lima et al 1983;Johnson et al 1984;Goldberg 1989). Although some studies on serial catheter data showed spontaneous improvement of the transpulmonary valve gradient in mild to moderate patients of PS (Leuker et al 1970;Danilowicz et al 1975), there are few noninvasive studies on the natural history of PS. In this study, to clarify the optimal age to perform not only invasive examination but also PTPV for patients with mild to moderate PS, we retrospectively surveyed the changes in peak V measured by serial Doppler echocardiography.…”