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January 1963

Ventricular Function and Pulmonary Insufficiency: Right and Left Ventricular Function After Pulmonary Insufficiency With and Without Stenosis

Author Affiliations

From the Cardiovascular Unit, Presbyterian Medical Center.

Arch Surg. 1963;86(1):110-117. doi:10.1001/archsurg.1963.01310070112015

During surgical correction of congenital defects such as tetralogy of Fallot, which include severe pulmonary stenosis, it is sometimes necessary to produce pulmonary valvular incompetence in order to obtain a right ventricular outflow tract of adequate diameter. Some published data indicate that pulmonary insufficiency is well tolerated in animals,1,2 but other data indicate that it is associated with pronounced right ventricular failure.3

In a recent review of our own data over the past several years, the creation of severe pulmonary insufficiency in patients seemed associated with increased mortality and morbidity, and there was suggestive evidence that patients with residual pulmonary stenosis did better than those with widely opened right ventricular outflow tracts. In fact, total abolition of the systolic gradient between right ventricle and pulmonary artery seemed, in a small series of patients with significant pulmonary insufficiency, to be strongly associated with severe right-sided failure or even post-operative