Explain Indications for Surgery of Congenital Pulmonary Stenosis ?

Interventional treatment is required for all neonates presenting with critical pulmonary valvar stenosis. This call be achieved percutaneously except when there is severe pulmonary annular hypoplasia (Z value of - 4 or less). Such a case will require open pulmonary valvotomy and trans annular patching under cardio-pulmonary bypass. When there is severe reduction in the size of RV, a systemic to pulmonary shunt is combined with this procedure. Ultimately they will need a Fontan like operation at about two years.

Less critical pulmonary stenosis may present in an infant, child or adult. Severe stenosis will have features of right heart failure and cyanosis due to right to left shunting at atria level. Children presenting after infancy may have mild, moderate or severe obstruction. When right ventricular peak systolic pressure is less than 50 mm of Hg and RV-PA gradient less than 25 min of Hg, they will have normal life expectancy and except for periodic follow-up, no intervention is required. RV peak pressure less than 80 mm of Hg and peak gradient less than 50 mm of Hg come in the category of moderate pulmonary stenosis. They require closer follow-up and intervention if the condition progresses. Patients presenting with gradients more that 50 mm of Hg and peak RV pressure more than 80 mm should have intervention.