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Surgically treated pulmonary stenosis: over 50 years of follow-up

Published online by Cambridge University Press:  21 July 2015

Eva A. Nielsen Open the ORCID record for Eva A. Nielsen [Opens in a new window]  and
Vibeke E. Hjortdal
Eva A. Nielsen*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
*
Correspondence to: E. A. Nielsen, Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Tel: +457 845 3082; Fax: +457 845 3079; E-mail: eva.nielsen@clin.au.dk
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Abstract

Background

Surgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.

The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.

Results

The total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.

Conclusion

Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.

Keywords

Pulmonary stenosisCHDsurgerysurvivaloutcome
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 860 - 866
Copyright
© Cambridge University Press 2015 

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