Closed Valvotomy for Pulmonary Valvar Stenosis

Direct vision methods for surgical relief of pulmonary valvar stenosis with intact ventricular septum are now widely advocated5,7,9-11,16-18as the preferred, if not the only acceptable, form of treatment for most patients with this abnormality. In our hands, however, experience with the closed, transventricular approach has been satisfactory enough to warrant its continued trial. Using this method in cases diagnosed as valvar pulmonary stenosis with intact ventricular septum, we have found that mortality and morbidity are low, valvar stenosis can be relieved completely, and any associated infundibular stenosis will regress if the valvotomy is adequate. Many surgeons have abandoned closed valvotomy because results by the initial technique of Sellors15and Brock3were unsatisfactory over a prolonged period of observation. This led to a variety of open techniques beginning with Varco's transarterial approach at normal body temperature with temporary inflow occlusion.19Because of fatal cerebral insult in