Abstract:
OBJECTIVE:This study attempted to determine the optimal therapeutic interventions by risk-adjusted comparisons of early and intermediate-term outcomes. BACKGROUND:The variety of interventions and the small case load at individual institutions have delayed the generation of reliable information concerning therapy for this condition. METHODS:In this prospective 27-institution study, 101 neonates were consecutively enrolled (between January 1, 1987 and January 1, 1991). Treatment was determined by the physicians. Demographic and morphologic details were tabulated. Dimensions of the pulmonary "anulus" and tricuspid anulus were measured on echocardiograms, and right ventricular cavity size was estimated. Right ventricular-pulmonary trunk pressure gradients were tabulated. Numerous analyses were made. RESULTS:Severe pulmonary valve stenosis and an intact ventricular septum were present in all patients. The right ventricular-pulmonary trunk junction ("anulus") was severely narrowed in 15%. Right ventricular cavity size was severely reduced in 4%. The tricuspid valve was small in 15% of patients; its diameter was poorly correlated with right ventricular cavity size. Eighty-nine percent and 81% of patients survived > or = 1 month and 4 years, respectively, after the initial procedure. Multivariable analysis identified no patient-specific risk factors for death. Only open pulmonary valvotomy without a support technique was uniformly a procedural risk factor; under some circumstances, transannular patching without a shunt was a risk factor. The right ventricular-pulmonary trunk gradient immediately after valvotomy was < 30 mm Hg in 81% of patients and was similar after surgical and balloon valvotomy. In 74% of patients, no intervention was required after the first accomplished intervention. CONCLUSIONS:Marked variation in morphology is uncommon in critical pulmonary stenosis in neonates. Percutaneous balloon valvotomy and certain types of surgical valvotomy are optimal initial procedures. The unusual situation of a small pulmonary "anulus" may initially require a transannular patch and a systemic-pulmonary artery shunt.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Hanley FL,Sade RM,Freedom RM,Blackstone EH,Kirklin JWdoi
10.1016/0735-1097(93)90833-msubject
Has Abstractpub_date
1993-07-01 00:00:00pages
183-92issue
1eissn
0735-1097issn
1558-3597pii
0735-1097(93)90833-Mjournal_volume
22pub_type
杂志文章,多中心研究abstract::Ultrafast computed tomography has been reported to be an accurate method of measuring left ventricular mass in dogs. To assess the interstudy, intraobserver and interobserver variability of left ventricular myocardial mass measurements in humans, left ventricular myocardial volume was measured three times within 24 h ...
journal_title:Journal of the American College of Cardiology
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abstract::Recent progress and evolution in device engineering, surgical implantation practices, and periprocedural management have advanced the promise of durable support with left ventricular assist systems (LVAS) in patients with stage D heart failure. With greater uptake of LVAS globally, a growing population of LVAS recipie...
journal_title:Journal of the American College of Cardiology
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pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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doi:10.1016/s0735-1097(10)80066-x
更新日期:1990-02-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2005-08-02 00:00:00
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doi:10.1016/j.jacc.2008.08.074
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journal_title:Journal of the American College of Cardiology
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pub_type: 杂志文章
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更新日期:2011-03-08 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2011.12.007
更新日期:2012-03-13 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.02.062
更新日期:2005-06-07 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90462-7
更新日期:1988-10-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2013-09-03 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00434-9
更新日期:1999-11-15 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:2000-06-01 00:00:00
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更新日期:2006-10-03 00:00:00