Pulmonary valve stenosis surgery

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

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Surgery

ACC/AHA Guidelines - Recommendations for intervention in patients with valvular Pulmonary Stenosis (DO NOT EDIT)

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) "

ACC/AHA Guidelines - Recommendation for clinical evaluation and follow-up after intervention (DO NOT EDIT)

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) "

Post Surgical Complications

After surgical valvotomy, complications that can develop are

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