Echocardiogram in the Diagnosis and Surgical Treatment of Patients with Severe Pulmonary Stenosis and Intact Ventricular Septum

For the application of surgery without catheterization we studied 9 neonates with critical pulmonary stenosis (PS), or pulmonary atresia with intact ventricular septum (PA:IVS) and 9 infant with severe PS or PA:IVS who needed urgent palliation or correction. All patients were diagnosed by only M-mode, 2-D (two-dimensional) and Doppler echocardiography. Operative procedures and postmortem findings were evaluated. With the identification of the presence of mobile valves with normal thickness by M-mode and 2-D echocardiograhpy, 11 patients were diagnosed to have classical pulmonary stenosis. In 4 patients, the dysplastic valve was identified based on the following characteristics: the valve was very thick and immobile. systolic dome was absent, and valve Ieaflets were partially adherent to the pulmonary artery wall. Doppler techniques were used confidently for qualifications of the severity of the pulmonary stenosis, presence of PDA (patent ductus arteriosus) and tricuspid regurgitation. Pulmonary atresia was considered in 3 patients with the observation of the absence of both "a" waves and opening movements in M-mode and 2-D echocardiograms. In Doppler echocardiogram, a high velocity continuous flow pattern due to left to right ductal jet flow in the main pulmonary artery and the absence of the anterior systolic flow due to pulmonary stenosis con- -firmed the diagnosis of pulmonary atresia. Results obtained by M-mode, 2-D, and Doppler echocardiography were confirmed by surgical findings and autopsy studies. We conclude that preoperative diagnosis of neonates with critical pulmonary stenosis and pulmonary atresia with intact ventricular septum by M-mode, 2-D and Doppler echocardiography, is clearly an alternative method to cardiac catheterization which can increase operative morbidity and mortality.