| From your Guide Dr.MANI |  | |
Pulmonary Stenosis | ||
| From your Guide Dr.MANI | | |
Pulmonary Stenosis | ||
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What about surgery - Does it have a role at all ?
Certainly. Though at the rate these "catheter-pushers" are going, we "scalpel-wielders" may soon
be out of business !
Most cases of PS due to pulmonary valve narrowing are candidates for BPV. But when BPV is not
possible due to non-availability or lack of experience, surgery may be needed. Also, when other
conditions co-exist it may be better to offer surgery to correct all defects at one sitting.
What operations are performed for PS ?
The common procedure is called Open Pulmonary Valvotomy (OPV). This is an "open-heart"
operation, and is done after the patient is hooked up to a heart-lung machine. The pulmonary artery
is opened, and the narrow pulmonary valve examined. Usually, the leaflets of the pulmonary valve
are stuck to the wall of the pulmonary artery - "tethering" - and to one another along well-defined
lines - "cuspal fusion". The valve is opened-up by dividing its leaflets along the lines of attachment
using a scalpel.
Additional sites of block are sought. If there is an obstruction below the valve due to abnormal
muscle bundles, these are divided and removed. If the pulmonary artery or its branches are narrow,
they are widened by using a patch of pericardium to increase their size - similar to the repair used in
Tetralogy of Fallot.
Sometimes the valve may be extremely narrow and this alone is not enough. In such cases, a
Trans-Annular Patch repair may be indicated. In this repair, a cut is made across the narrow area,
and the opened up portion is roofed using a patch of pericardium or synthetic fabric.
Other defects that occur in addition to PS need correction at the same operation. The commonest
of these are ASD and PDA.
What are the risks of surgery ?
Surgery for PS is relatively safe. The complication rate is very low, and includes those common for
any open-heart operation. This includes bleeding needing blood transfusions and rhythm
disturbances - arrhythmia. Sometimes the relief of block may be incomplete due to technical
problems. Most types of PS however can be effectively relieved by operation. Also, any additional
defects can be treated at the same time.
What about the long term effects ?
Most patients operated for pulmonary stenosis go on to lead normal lives. The risk of late
complications is very low. In most children, as growth occurs, the pulmonary valve also becomes
larger, and this itself reduces the stenosis to some extent. The potential problems are rhythm
disturbances and "late" pulmonary valve leak due to injury at the time of operation.
If there's anything more you want to read about, or some areas which aren't clear enough, don't
hesitate to write and let me know.
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Copyright 1998, All rights reserved. |
