Polansky D B, Clark E B, Doty D B
Ann Thorac Surg. 1985 Feb;39(2):159-64. doi: 10.1016/s0003-4975(10)62557-x.
Twenty-four patients less than 3 years old underwent operation for pulmonary stenosis. Pulmonary dysplasia was diagnosed preoperatively in only 4 patients; in 20 patients the lesion was categorized simply as pulmonary stenosis. At operation, more severe valve deformities were often present in patients less than 2 years of age. Preoperative evaluation did not reveal the extent of the deformity in 7 additional patients. The deformities included not only valvular dysplasia (thickened redundant valve cusps) but also supravalvular and annular abnormalities. Relief of obstruction was obtained only when all components of the obstructive abnormality were relieved. Patch angioplasty of the right ventricular outflow tract was necessary in 13 patients with complex morphology. Valvotomy was effective only for pulmonary stenosis due to pure commissural fusion. A spectrum of the morphology of pulmonary stenosis is recognized, with more complex lesions than simple commissural fusion identified in younger children. The more complex lesions may require more extensive operations (outflow tract patch) to completely relieve the obstructive pathological condition in the outflow tract.
24例3岁以下儿童接受了肺动脉狭窄手术。术前仅4例诊断为肺发育不良；20例病变仅归类为肺动脉狭窄。手术时，2岁以下患者常存在更严重的瓣膜畸形。另有7例患者术前评估未发现畸形程度。畸形不仅包括瓣膜发育不良（瓣膜叶增厚、冗长），还包括瓣上和瓣环异常。只有当梗阻性异常的所有组成部分都得到缓解时，才能解除梗阻。13例形态复杂的患者需要进行右心室流出道补片血管成形术。瓣膜切开术仅对单纯交界融合所致的肺动脉狭窄有效。现已认识到肺动脉狭窄的一系列形态，在年幼儿童中发现的病变比单纯交界融合更为复杂。更复杂的病变可能需要更广泛的手术（流出道补片）来完全解除流出道的梗阻性病理状况。
