Balloon valvuloplasty: Shedding additional light: Reply to the letter to the editor by Mario Cazzaniga

✍ Scribed by Mendelsohn, Alan M. ;Banerjee, Anirban ;Meyer, Richard A. ;Schwartz, David C.

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 73 KB
• Volume: 41
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/(sici)1097-0304(199706)41:2<227::aid-ccd26>3.0.co;2-l

✦ Synopsis

We appreciate Dr. Cazzaniga's comments, and we would like to respond to some of his questions. The patient whom he cites with progressive supravalvar stenosis did indeed have very subtle supravalvar narrowing at the time of her initial pulmonary valvuloplasty. However, no significant systolic gradient was identified at the time of her cardiac catheterization, and we felt it best to follow this patient's supravalvar stenosis conservatively. The supravalvar stenosis progressed minimally but has now regressed to an insignificant degree without requiring surgical intervention. All of the patients in Group B whom we presented in our report have echocardiographic evidence of residual right ventricular outflow tract obstruction located primarily at the valve with only minimal subvalvar and no supravalvar disease.

We agree with Dr. Cazzaniga's argument concerning the appearance of the pulmonary valve on the spot cineangiographic images submitted, that ''. . . a constellation of angio-configuration . . . could be observed, and even though suboptimal, patients with these appearances will have a nearly good result. . . .'' This is the exact