Isolated Pulmonary Stenosis by Open Operation during Pulmonary Bypass

SURGICAL treatment of pulmonary stenosis has advanced to the point where a choice of several operative technics is available. This study constitutes a comparative review of the late recatheterization results in the open versus closed method of pulmonary valvuloplasty. Doyen reported an unsuccessful attempt to relieve pulmonary stenosis by transventricular valvulotomy in 1913.1 In 1948, Sellors reported a successful transventricular valvulotomy,2 and Brock reported three successful cases of pulmonary valvulotomy.3 The transventricular valvulotomy, commonly called the Brock procedure, has been used extensively. Varco introduced pulmonary valvulotomy under direct vision by a transarterial approach, inflow occlusion, and normothermia.4 Swan, combining hypothermia and inflow occlusion,5 increased the length of time available in correcting valvular stenosis by direct vision. With total cardiopulmonary bypass, anatomically precise valvulotomy, deliberate infundibular resection when necessary, and repair of associated defects can be done. There are several reports of disappointing results following closed procedures for pulmonary stenosis because of failure to relieve the obstruction.5-11 In 1956 we reported the preoperative and postoperative right ventricu-