Abstract
Between August, 1985 and June, 1992, we treated surgically nine patients with pure pulmonary atresia (PPA)and two patients with critical pulmonary stenosis (CPS). The age and body weight at first operation ranged from 5 to 102days (32±35(mean and standard deviation)), and from 1.9 to 5.9kg (3.3±1.1), respectively. Surgical procedures at first operation were as follows ; pulmonary valvotomy alone (Group A ; 4 patients), valvotomy and Blalock-Taussig shunt (Group B ; 6 patients). Group A patients had good results and prognoses after the first definitive operation. We lost 4 patients in Group B after first operation because of hypoxia and heart failure. Percutaneous transluminal balloon valvuloplasty (PTBV) was also performed in some patients, either after some surgical procedure or as a first therapeutic maneuver. This palliative procedure was effective for the recovery from hypoxia, for average capillary oxygen partial pressure improved to 40.4mmHg from 26.7mmHg. But as far as the development of the right ventricle (RV)is concerned, first operation was not always effective, because average RV volume remained subnormal (76% of normal value). Decompression of supersystemic RV pressure (RVP) was not remarkable (RVP/LVP : from 1.33 to 1.05). On the other hand, PTBV was good enough to decompress the supersystemic RVP and to improve hypoxia (RVP/LVP : 0.72 from 1.23, 0.66 from 1.10, PaO2 : 40.9mmHg, 39.6mmHg from 26.7mmHg, 26.0mmHg). PTBV proved to be an useful adjunctive method for CPS and PPA after valvotomy.
