CINE-ANGIOCARDIOGRAPHIC STUDIES OF THE OUTFLOW TRACT IN ISOLATED PULMONARY VALVULAR STENOSIS

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Abstract
Hemodynamic con-siderations have led to the concept of acquired infundibular muscular hypertrophy forming a further obstruction to the outflow of blood from the right ventricle in patients with severe isolated valvular pulmonary stenosis. An infundibular pressure gradient may become apparent following successful pulmonary valvotomy. This gradient can be reduced immediately by infundibular resection or may regress spontaneously over some months. It is suggested that selective cine-angiocardiography of the right ventricular outflow tract and cardiac catheterization with combined recording of the pressure pulse and intracardiac electrogram provide the most complete analysis of the nature of the obstruction in pulmonary stenosis. The cine-angiocar diographic findings lend further support to the concept of infundibular obstruction from muscular hypertrophy and show narrowing of the infundibular lumen roughly proportional to the severity of the valvular pulmonary stenosis. Dilatation of the outflow tract in severe cases is brief and incomplete, and its association with the muscular hypertrophy invites the use of the term "muscle-bound outflow tract".