Impaired exercise response and other residua of pulmonary stenosis after valvotomy.

The operation of pulmonary valvotomy has been so brilliantly successful that its failure to achieve an ideal end result in certain cases deserves comment. In this report, some residual effects of isolated pulmonary stenosis that may persist after complete valvotomy will be considered. It will be seen that all of these are the result of very severe stenosis or of long-delayed relief of stenosis of less severe degree. They constitute, therefore, a plea for early recognition of pulmonary stenosis and accurate assessment of its severity, so that operation, where needed, may not be unwarrantably delayed. The conditions to be considered fall into two groups, each of which will be presented and discussed separately. Group I. Results of right ventricular myocardial fibrosis: (A) impaired response to exercise, and (B) persistence of reversed interatrial shunt. Group II. Results of persistent right ventricular hypertrophy.