Pulmonary valve stenosis surgery: Difference between revisions

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(/* Recommendations for Intervention (DO NOT EDIT) {{cite journal |author=Warnes CA, Williams RG, Bashore TM, et al. |title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Card...)
 
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==Surgery==
==Surgery==
===ACC/AHA Guidelines - Recommendations for intervention in patients with valvular Pulmonary Stenosis (DO NOT EDIT)===
===Post Surgical Complications===
After surgical valvotomy, beware the patients of following complications that can develop in next >20 years are
* Arrythmias
* Right ventricle enlargement
* Tricuspid regurgitation
* Pulmonary regurgitation
 
==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
 
===Indications for Balloon Valvotomy Adolescents (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Balloon valvotomy is recommended in adolescent and young adult patients with [[pulmonic stenosis]] who have [[exertional dyspnea]],                                          [[angina]], [[syncope]], or [[presyncope]] and an RV–to–pulmonary artery peak-to-peak gradient greater than 30 mm Hg at [[Cardiac catheterization|catheterization]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Balloon valvotomy is recommended in asymptomatic adolescent and young adult patients with [[pulmonic stenosis]] and RV–to–pulmonary                                          artery peak-to-peak gradient greater than 40 mm Hg at [[Cardiac catheterization|catheterization]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Balloon valvotomy is not recommended in asymptomatic adolescent and young adult patients with [[pulmonic stenosis]] and RV–to–pulmonary                                    artery peak-to-peak gradient less than 30 mm Hg at [[Cardiac catheterization|catheterization]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Balloon valvotomy may be reasonable in asymptomatic adolescent and young adult patients with [[pulmonic stenosis]] and an RV–to–pulmonary                                    artery peak-to-peak gradient 30 to 39 mm Hg at [[Cardiac catheterization|catheterization]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
 
==2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease (DO NOT EDIT) <ref name="pmid19038677">{{cite journal |author=Warnes CA, Williams RG, Bashore TM, ''et al.'' |title=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). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=J. Am. Coll. Cardiol. |volume=52 |issue=23 |pages=e143–263 |year=2008 |month=December |pmid=19038677 |doi=10.1016/j.jacc.2008.10.001 |url=}}</ref>==
 
===Recommendations for Intervention (DO NOT EDIT) <ref name="pmid19038677">{{cite journal |author=Warnes CA, Williams RG, Bashore TM, ''et al.'' |title=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). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=J. Am. Coll. Cardiol. |volume=52 |issue=23 |pages=e143–263 |year=2008 |month=December |pmid=19038677 |doi=10.1016/j.jacc.2008.10.001 |url=}}</ref>===


{|class="wikitable"
{|class="wikitable"
Line 14: Line 51:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Balloon valvotomy is recommended for asymptomatic patients with a domed pulmonary valve and a peak instantaneous Doppler gradient greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg (in association with less than moderate pulmonary valve regurgitation).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Balloon]] valvotomy is recommended for [[asymptomatic]] patients with a domed [[pulmonary valve]] and a peak instantaneous Doppler gradient greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg (in association with less than moderate [[pulmonary valve]] regurgitation).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Balloon valvotomy is recommended for symptomatic patients with a domed pulmonary valve and a peak instantaneous Doppler gradient greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg (in association with less than moderate pulmonary regurgitation).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Balloon]] valvotomy is recommended for symptomatic patients with a domed [[pulmonary valve]] and a peak instantaneous Doppler gradient greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg (in association with less than moderate [[pulmonary regurgitation]]).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''Surgical therapy is recommended for patients with severe PS and an associated hypoplastic pulmonary annulus, severe pulmonary regurgitation, subvalvular PS, or supravalvular PS. Surgery is also preferred for most dysplastic pulmonary valves and when there is associated severe TR or the need for a surgical Maze procedure.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Surgical]] therapy is recommended for patients with severe [[PS]] and an associated [[hypoplastic]] [[pulmonary]] annulus, severe [[pulmonary regurgitation]], subvalvular [[PS]], or supravalvular [[PS]]. Surgery is also preferred for most dysplastic [[pulmonary valves]] and when there is associated severe TR or the need for a surgical [[Maze procedure]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''Surgeons with training and expertise in CHD should perform operations for the RVOT and pulmonary valve.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Surgeons with training and expertise in [[congential heart disease|CHD]] should perform operations for the [[RVOT]] and [[pulmonary valve]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
|}


Line 27: Line 64:
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''Balloon valvotomy is not recommended for asymptomatic patients with a peak instantaneous gradient by Doppler less than 50 mm Hg in the presence of normal cardiac output.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Balloon]] valvotomy is not recommended for [[asymptomatic]] patients with a peak instantaneous gradient by Doppler less than 50 mm Hg in the presence of normal [[cardiac output]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[Balloon]] valvotomy is not recommended for [[symptomatic]] patients with [[PS]] and severe [[pulmonary regurgitation]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.'''Balloon valvotomy is not recommended for symptomatic patients with PS and severe pulmonary regurgitation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' [[Balloon]] valvotomy is not recommended for [[symptomatic]] patients with a peak instantaneous gradient by Doppler less than 30 mm Hg.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.'''Balloon valvotomy is not recommended for symptomatic patients with a peak instantaneous gradient by Doppler less than 30 mm Hg.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Balloon]] valvotomy may be reasonable in [[asymptomatic]] patients with a dysplastic [[pulmonary valve]] and a peak instantaneous gradient by Doppler greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' [[Balloon]] valvotomy may be reasonable in selected [[symptomatic]] patients with a dysplastic [[pulmonary valve]] and peak instantaneous gradient by Doppler greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
|}
===Recommendation for Clinical Evaluation and Follow-up after Intervention (DO NOT EDIT) <ref name="pmid19038677">{{cite journal |author=Warnes CA, Williams RG, Bashore TM, ''et al.'' |title=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). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=J. Am. Coll. Cardiol. |volume=52 |issue=23 |pages=e143–263 |year=2008 |month=December |pmid=19038677 |doi=10.1016/j.jacc.2008.10.001 |url=}}</ref>===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Periodic clinical follow-up is recommended for all patients after surgical or balloon pulmonary valvotomy, with specific attention given to the degree of [[pulmonary regurgitation]]; [[RV]] pressure, size, and function; and [[TR]]. The frequency of follow-up should be determined by the severity of hemodynamic abnormalities but should be at least every 5 years.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
==Sources==
*2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>
*2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease - Recommendation for clinical evaluation and follow-up after intervention <ref name="pmid19038677">{{cite journal |author=Warnes CA, Williams RG, Bashore TM, ''et al.'' |title=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). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=J. Am. Coll. Cardiol. |volume=52 |issue=23 |pages=e143–263 |year=2008 |month=December |pmid=19038677 |doi=10.1016/j.jacc.2008.10.001 |url=}}</ref>


==References==
==References==

Latest revision as of 20:31, 13 November 2012

Pulmonary valve stenosis

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

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Overview

Surgery

Post Surgical Complications

After surgical valvotomy, beware the patients of following complications that can develop in next >20 years are

  • Arrythmias
  • Right ventricle enlargement
  • Tricuspid regurgitation
  • Pulmonary regurgitation

2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]

Indications for Balloon Valvotomy Adolescents (DO NOT EDIT) [1]

Class I
"1. Balloon valvotomy is recommended in adolescent and young adult patients with pulmonic stenosis who have exertional dyspnea, angina, syncope, or presyncope and an RV–to–pulmonary artery peak-to-peak gradient greater than 30 mm Hg at catheterization. (Level of Evidence: C)"
"2. Balloon valvotomy is recommended in asymptomatic adolescent and young adult patients with pulmonic stenosis and RV–to–pulmonary artery peak-to-peak gradient greater than 40 mm Hg at catheterization. (Level of Evidence: C)"
Class III
"1. Balloon valvotomy is not recommended in asymptomatic adolescent and young adult patients with pulmonic stenosis and RV–to–pulmonary artery peak-to-peak gradient less than 30 mm Hg at catheterization. (Level of Evidence: C)"
Class IIb
"1. Balloon valvotomy may be reasonable in asymptomatic adolescent and young adult patients with pulmonic stenosis and an RV–to–pulmonary artery peak-to-peak gradient 30 to 39 mm Hg at catheterization. (Level of Evidence: C)"

2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease (DO NOT EDIT) [2]

Recommendations for Intervention (DO NOT EDIT) [2]

Class I
"1. Balloon valvotomy is recommended for asymptomatic patients with a domed pulmonary valve and a peak instantaneous Doppler gradient greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg (in association with less than moderate pulmonary valve regurgitation).(Level of Evidence: B) "
"2. Balloon valvotomy is recommended for symptomatic patients with a domed pulmonary valve and a peak instantaneous Doppler gradient greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg (in association with less than moderate pulmonary regurgitation).(Level of Evidence: C) "
"3. Surgical therapy is recommended for patients with severe PS and an associated hypoplastic pulmonary annulus, severe pulmonary regurgitation, subvalvular PS, or supravalvular PS. Surgery is also preferred for most dysplastic pulmonary valves and when there is associated severe TR or the need for a surgical Maze procedure.(Level of Evidence: C) "
"4. Surgeons with training and expertise in CHD should perform operations for the RVOT and pulmonary valve.(Level of Evidence: B) "
Class III
"1. Balloon valvotomy is not recommended for asymptomatic patients with a peak instantaneous gradient by Doppler less than 50 mm Hg in the presence of normal cardiac output.(Level of Evidence: C) "
"2. Balloon valvotomy is not recommended for symptomatic patients with PS and severe pulmonary regurgitation.(Level of Evidence: C) "
"3. Balloon valvotomy is not recommended for symptomatic patients with a peak instantaneous gradient by Doppler less than 30 mm Hg.(Level of Evidence: C) "
Class IIb
"1. Balloon valvotomy may be reasonable in asymptomatic patients with a dysplastic pulmonary valve and a peak instantaneous gradient by Doppler greater than 60 mm Hg or a mean Doppler gradient greater than 40 mm Hg.(Level of Evidence: C) "
"2. Balloon valvotomy may be reasonable in selected symptomatic patients with a dysplastic pulmonary valve and peak instantaneous gradient by Doppler greater than 50 mm Hg or a mean Doppler gradient greater than 30 mm Hg.(Level of Evidence: C) "

Recommendation for Clinical Evaluation and Follow-up after Intervention (DO NOT EDIT) [2]

Class I
"1. Periodic clinical follow-up is recommended for all patients after surgical or balloon pulmonary valvotomy, with specific attention given to the degree of pulmonary regurgitation; RV pressure, size, and function; and TR. The frequency of follow-up should be determined by the severity of hemodynamic abnormalities but should be at least every 5 years.(Level of Evidence: C) "

Sources

  • 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [1]
  • 2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease - Recommendation for clinical evaluation and follow-up after intervention [2]

References

  1. ↑ 1.0 1.1 1.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 2.2 2.3 Warnes CA, Williams RG, Bashore TM; et al. (2008). "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). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J. Am. Coll. Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677. Unknown parameter |month= ignored (help)

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