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Does mild pulmonary stenosis progress during childhood? A study of its natural course
Julio Ardura1, Carmen Gonzalez, Jesus Andres
1Pediatric Cardiology, University Hospital, Facultad de Medicina,Valladolid, Spain. ardura@ped.uva.es
Insights
Mild pulmonary stenosis in children with gradients below 40 mmHg is stable. These patients, aged over 6 months, do not require treatment and can be monitored every two years.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Medical Diagnostics
Background:
- Congenital pulmonary valvular stenosis (CPVS) management is debated, particularly regarding gradient changes during follow-up.
- Determining the need for treatment in pediatric patients with CPVS is crucial.
Purpose of the Study:
- To investigate the natural history of CPVS in pediatric patients.
- To determine if a gradient below 50 mmHg at diagnosis indicates a stable or decreasing trend in CPVS.
Main Methods:
- A 7-year follow-up study of 35 untreated pediatric patients with isolated pulmonary stenosis.
- Utilized Doppler echocardiography and clinical formulas to measure pressure gradients.
- Analyzed changes using statistical methods including Student's t-test and Pearson correlation.
Main Results:
- No significant changes in clinical symptoms or physical examination findings were observed.
- Cardiac enlargement decreased on ECG and chest X-ray (p<0.0001 and p<0.0007, respectively).
- A statistically significant decreasing trend in pulmonary stenosis gradient was noted during follow-up (p<0.026).
Conclusions:
- The observed gradient trend supports the stable nature of mild pulmonary stenosis.
- Pediatric patients over 6 months with initial gradients <40 mmHg remained stable and did not require intervention.
- Follow-up intervals for these patients can be extended to 2 years or more.
Background:
Increase in the gradient in congenital pulmonary valvular stenosis during follow-up is a subject of controversy and could determine the need for treatment in pediatric patients.
Hypothesis:
It is postulated that a gradient <50 mmHg shows a stable or decreasing tendency at follow-up for congenital pulmonary valvular stenosis.
Methods:
Thirty-five patients with pulmonary stenosis, isolated and not treated, were followed for 7 years (interquartilic rank 5.7 years) at 1.5-year intervals. Clinical and complementary tests (electrocardiogram, x-ray, Doppler echocardiogram) were undertaken. The gradient was measured by Doppler and by using the clinical formula derived from the New England Study (Ellison). The changes observed from the initial to the final consultation were analyzed by means of the Student's t-test, paired Wilcoxon, and Pearson correlation coefficient.
Results:
No significant changes were noted on symptoms or physical examination. Signs of cardiac enlargement diminished on both ECG (R wave in V1, p<0.0001) and x-ray (cardiothoracic ratio, p<0.0007), with a decreasing gradient trend during the follow-up period (p<0.026) as well.
Conclusions:
The gradient trend confirms the stable nature of mild pulmonary stenosis. In our study, we found that patients aged >6 months, whose gradients were below 40 mmHg at the time of diagnosis, remained stable and required no treatment. Furthermore, the follow-up control and clinical management of these patients may then be performed at intervals of 2 years or more.
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