Valvotomy for XXXX with intact @entity67 . A disciplined approach to achieve a functioning right ventricle.

@entity1146 @entity1 @entity67
During the past 20 years, a consistent policy in applying early valvotomy has resulted in a unique opportunity to appraise the long-term results of this approach in @entity1146 with intact @entity67 . Since 1964, 27 of 35 @entity1 with @entity1146 with intact @entity67 had type 1 or 2 right ventricle, 25 of these had early valvotomy, seven with and 18 without concomitant shunt. The remaining two @entity1 with type 2 right ventricle and the eight @entity1 with type 3 right ventricle received a shunt alone. Overall operative mortality was 34%; for those @entity1 weighing more than 3 kg and those operated upon since 1977, it was 18% and 16%, respectively. There were 17 survivors of early valvotomy: 11 had valvotomy alone and six had valvotomy with shunt; 12 had type 1 right ventricle and five had type 2 right ventricle. Survival rates (+/- standard error) for these 17 @entity1 were 85% +/- 10% and 68% +/- 17% at 5 and 10 years, respectively. The probability of reoperation was 100% by 6 years of age; outflow patch reconstruction was employed in all @entity1 in whom reoperation has been performed. Aggressive follow-up and early recatheterization were essential features of management. Delayed reconstruction after shunt alone was unsuccessful in three @entity1 . Primary valvotomy without shunt is the operation of choice for @entity1 with @entity1146 with intact @entity67 and type 1 right ventricle. Concomitant shunt may be required for some @entity1 with type 1 and most with type 2 right ventricle, selected preoperatively by angiography or after valvotomy by clinical necessity. Delayed right ventricular reconstruction after shunt alone is not an acceptable approach when an outflow tract is present.
