Right ventricular outflow tract obstruction surgery

1. In patients with severe stenoses, there is impaired exercise tolerance and changes in the RV myocardium.
2. Surgery is indicated in patients with fatigability, DOE, cyanosis or CHF.
3. Surgery is recommended in the absence of symptoms if the gradient is greater than 75 mm Hg, and is also preferred if the gradient is as low as 50 to 60 mm Hg.
4. For those with gradients less than 50 mm Hg, then follow-up is recommended.
5. Long-term results of pulmonary valvuloplasty are not yet available, but short term results appear to be excellent.
   1. Restenosis is likely is the residual gradient is greater than 30 mm Hg.
   2. 79% of these patients have residual pulmonic regurgitation.
   3. Following these procedures there is a soft residual systolic murmur, a diastolic murmur of pulmonic insufficiency, and some regression of the EKG criteria of RVH.

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