VALVULOTOMY FOR PULMONARY VALVULAR STENOSIS

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Abstract
A report of clinical and operative experience in performing valvulotomies for relief of pulmonary valvular stenosis in 33 patients is given. 18 had pulmonary stenosis with a closed inter-ventricular septum; in 15 the stenosis was thought to be part of Fallot''s tetralogy. The mortality dropped from 50% in the first 11 patients to 18% in the last 22. The operation was considered dangerous in those over 20 yrs. of age. The increasing safety of the operation in younger age groups suggests that it is indicated to relieve dangerously high right ventricular pressure. The greatest deterrent to successful operation is the danger of sudden death, due probably to coronary insufficiency. Any sudden deterioration of the patient during operation should lead to immediate division of the valve. In Fallot''s tetralogy, the inability to demonstrate infundibular stenosis should lead to the suspicion of valvular stenosis. The pericardium should be opened to make a proper external examination of the heart.