scholarly journals Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

2020 ◽  
Vol 27 (3) ◽  
pp. 16-26
Author(s):  
Evgenii S. Baykov ◽  
Alexey V. Peleganchuk ◽  
Abdugafur J. Sanginov ◽  
Olga N. Leonova ◽  
Aleksandr V. Krutko
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Perioperative Complications ◽  
Sagittal Imbalance ◽  
Radiological Parameters ◽  
Results Of Treatment ◽  
Group I ◽  
Surgical Methods ◽  
Group Ii ◽  
Clinical And Radiological Results

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

scholarly journals Single- and multistage surgical treatment of patients with degenerative sagittal imbalance

2021 ◽  
Vol 18 (2) ◽  
pp. 44-53
Author(s):  
E. S. Baikov ◽  
A. V. Peleganchuk ◽  
A. J. Sanginov ◽  
O. N. Leonova ◽  
A. V. Krutko
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Charlson Comorbidity Index ◽  
Sagittal Imbalance ◽  
Group I ◽  
Duration Of Surgery ◽  
Comorbidity Index ◽  
Group Ii ◽  
Clinical And Radiological Results ◽  
High Charlson Comorbidity Index

Objective. To analyze the nearest clinical and radiological results of simultaneous and staged surgical treatment of patients with degenerative sagittal imbalance.Material and Methods. Retrospective monocentric cohort study included analysis of data from 54 patients who underwent simultaneous combination of surgical methods with obligatory corrective anterior fusion at the L4–L5 or at L4–L5 and L5–S1 levels (Group I, n = 27) or similar surgical intervention though divided into stages with an interval of 5 days or more (Group II, n = 27). A comparison of clinical, radiological, and operational data during inpatient treatment was carried out.Results. The duration of surgery was 410.93 ± 76.34 minutes in Group I and 594.63 ± 102.61 minutes in Group II (p = 0.000001); the  blood loss was 926.67 ± 378.63 ml versus 1345.19 ± 522.97 ml, respectively (p = 0.001575). Postoperative clinical and radiological parameters did not differ between groups: VAS back (p = 0.248647), VAS leg (p = 0.196140), PT (p = 0.115965), SVA (p = 0.208449), LL (p = 0.023654), LDI (p = 0.931646), PI-LL (p = 0.693045), GAP (p = 0.823504), and restoration of the ideal Russoly type (p = 0.111476). The incidence of perioperative complications in groups was comparable: 17 (62.96 %) in Group I and 15 (55.56 %) in Group II (p = 0.583171). Patients with a high Charlson comorbidity index had a significantly higher incidence of complications (p = 0.023471). The index of surgical invasiveness in Group I had a significant correlation with the total number of complications (r = 0.421332).Conclusion. Clinical and radiological results and the incidence of complications are comparable between single- and multistage approaches to correct sagittal balance disorders. In staged treatment, the total duration of surgery and the volume of blood loss are significantly higher. With a high Charlson comorbidity index and Mirza surgical invasiveness index, a multistage approach to the treatment of patients with sagittal imbalance is preferred.

scholarly journals THE USE OF VARIOUS TECHNOLOGIES IN THE SURGICAL TREATMENT OF DECOMPENSATED FORMS OF VARICOSE VEINS OF THE LOWER EXTREMITIES WITH UNILATERAL VALVULAR INCOMPETENCE OF THE GREAT SAPHENOUS AND ANTERIOR ACCESSORY SAPHENOUS VEIN

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
O. V. Sokolov
Keyword(s):  
Surgical Treatment ◽  
Radiofrequency Ablation ◽  
Varicose Veins ◽  
Pain Syndrome ◽  
Ulcer Recurrence ◽  
Average Area ◽  
Results Of Treatment ◽  
Group I ◽  
Group Ii ◽  
One Year

Abstract Purpose of the study. Comparative evaluation of the results of treatment of patients with varicose veins (VVs) in stage C6, with the valve incompetence of the trunks of GSV and ASSV in one lower limb, by traditional venectomy and radiofrequency ablation (RFA). Materials and methods. The study was conducted on the basis of MI «RCH n.a. І.І. Mechnikov», MNE «CCH №16» DCC and MC «JMC Menorah» from 2010 to 2020 yy. Included 43 patients: women – 29 (67,4%), men – 14 (32,6%). Age - from 29 to 74 years (average – 52,7 ± 10,8 years). Patients are divided into 2 groups. The I group (n = 22) included patients who underwent traditional venectomy of GSV and ASSV, the II group (n = 21) – patients who underwent RFA under local anestesia. The observation lasted 12 months. Results. The average area of ulcers ranged from 1 to 12 cm2. The average area of ulcers in group I was 6,3 ± 3,1 cm2, in group II – 6,2 ± 2,7 cm2. Complete epithelialization of ulcers occurred faster with the use of RFA (group II) – 38,1 ± 5,7 days against 44,7 ± 6,2 days in group I. After 3 months. the number of healed ulcers in group I. was 20 (83,3%), in II – 24 (96,0%). Ulcer recurrence one year after surgery occurred in 4 (5,6%) patients of group I, in group II there were no recurrences. After 6 months the difference between the severity of CVI (VSS) was 10,5 ± 2,8 points in group I and 13,9 ± 2,2 points in group II. Conclusions. 1. Surgical treatment of VVs at unilateral defeat of GSV and ASSV with use of RFA differs in the better profile of a postoperative pain syndrome, less traumatism, has the best indicators of recovery in comparison with a traditional venectomy. 2. Treatment with RFA in comparison with traditional phlebectomy one year after surgery had an advantage in the number of recurrences of trophic ulcers Keywords: varicose veins, venectomy, radiofrequency ablation, trophic ulcers.

scholarly journals The surgical correction of refractory venous trophic ulcers

2021 ◽  
pp. 38-46
Author(s):  
S. E. Katorkin ◽  
M. J. Kushnarchuk ◽  
M. A. Melnikov ◽  
A. A. Zhukov ◽  
P. F. Kravtsov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Complete Healing ◽  
Long Term Results ◽  
Group Iii ◽  
Results Of Treatment ◽  
Group I ◽  
Group Ii ◽  
Shave Therapy

Objectives. To study the effectiveness of layered dermatolipectomy and endoscopic fasciotomy in the surgical treatment of refractory venous trophic ulcers.Materials and methods. Patients (n = 105) of the C6 clinical class underwent crossectomy and short stripping. In group I (n = 35), free autodermoplasty of trophic ulcers with a perforated flap was performed. In group II (n = 36), shave therapy and autodermoplasty were performed. In group IIІ (n = 34), fasciotomy, shave therapy and autodermoplasty were performed. Long-term results of treatment were studied in the period from 1 to 12 months.Results. Complete healing of venous trophic ulcers was observed in group I at 49,4 ± 7,2, in II – at 31,4 ± 4,7, in III – at 32,1 ± 3,6 days сутки (t1-2 = 2,09; p1-2 = 0,049; t1-3 = 2,24; p1-3 = 0,024; t2-3 = 0,03; p2-3 = 0,763). Full engraftment of an autograft graft was recorded in 7 (19,4 %) patients of group I, in 27 (77,1 %) cases in group II and in 27 (79,4 %) patients of comparison group III (χ21-2 = 23,674; p1-2 = 0,001; χ21-3 = 25,173; p1-3 = χ22-3 = 0,052; p2-3 = 0,826).Conclusion. Layered dermatolipectomy with autodermoplasty and endoscopic decompression fasciotomy is an effective method for the treatment of persistent refractory venous trophic ulcers.

scholarly journals ANALYSIS OF THE CAUSES OF MECHANICAL COMPLICATIONS AFTER OSTEOSYNTHESIS OF THE LIMBS

2020 ◽  
pp. 47-59
Author(s):  
O. Pelypenko ◽  
O. Kovalov
Keyword(s):  
Surgical Treatment ◽  
Treatment Regimen ◽  
Mechanical Complications ◽  
Outpatient Unit ◽  
Results Of Treatment ◽  
Articular Fractures ◽  
Iatrogenic Complications ◽  
Group I ◽  
Post Operation ◽  
Group Ii

Summary. The complications, reported most frequently by physicians are: additions of an infection, impaired fracture union processes, the occurrence of persistent joint contractures, especially after intra-articular fractures. Mechanical-related complications associated with bone-fixing devices are of particular importance. The information mechanical complications in the literature is rather controversial. Particularly debatable is the identification of any specific backgrounds of these complications. Virtually no attention is paid to the behavioral or social aspects of the issue, and the quality of the rehabilitation regime. Objective. Analysis of the background of the complications after surgical treatment, associated with mechanical factors, and identification of the means able to prevent them. Material and methods. The results of treatment of 36 patients operated on for fractures of their extremities, who had complications related to the inadequate mechanical fixation of their broken bones. The onset of complications ranged from 5 days to 1 year from the date of surgery. All patients were divided into 2 groups: Group I (iatrogenic) - 10 patients with iatrogenic complications; Group II (patient-dependent) - 26 patients with clearly identified patient-dependent disorders. Results. There were 15 fractures of a retainer (or its elements) and 21 cases of migration or deformation of structures. The most problematic segment was the proximal thigh, which, in our opinion, has a clear age dependence. Analyzing the errors of surgical treatment (group I), we have assumed that they could be prevented by the timely correction of postoperative complications. The prescribed treatment regimen was violated in 72,2% of cases (group II). 13 patients (50%) reported a repeated trauma in the early post-operative period. Conclusions. Prevention of mechanically-induced complications should be based on the adherence to surgical protocols, dynamic observation of the patients in the post-operation period through tight relations with the outpatient unit, considering both somatic and psychological criteria, and timely correction of the treatment regimen.

Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

scholarly journals Results of modern tuboperitoneal infertility treatment

2009 ◽  
Vol 66 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Drenka Turjacanin-Pantelic ◽  
Dragana Bojovic-Jovic ◽  
Biljana Arsic ◽  
Eliana Garalejic
Keyword(s):  
Statistical Analysis ◽  
Surgical Treatment ◽  
Infertility Treatment ◽  
P Value ◽  
Modern Approach ◽  
Vitro Fertilization ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background/Aim. A modern approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infertility treatment by the use of laparoscopy and classical laparotomy. Methods. A retrospectiveprospective study on 66 women treated operatively form tuboperitoneal infertility was performed. Data from patient's anamnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant. Results. Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.4%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups. Conclusion. Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored.

scholarly journals Outcomes of ophtalmologic surgical procedures of esotropia in children and adolescents

2008 ◽  
Vol 65 (8) ◽  
pp. 627-631
Author(s):  
Tamara Kljakovic-Avramovic ◽  
Miroslav Vukosavljevic ◽  
Sinisa Avramovic
Keyword(s):  
Surgical Treatment ◽  
Prospective Study ◽  
Children And Adolescents ◽  
Deviation Angle ◽  
Group Iii ◽  
Military Medical Academy ◽  
Group I ◽  
Medical Academy ◽  
Group Ii ◽  
Common Manifestation

Background/Aim. Esotropia is the most common manifestation form of strabism accompanied by refraction deviations and amblyopia. The aim of this prospective study was to present the outcomes of surgical treatment of esotropia in children and adolescents. Methods. Within the period from January 1st 2006 to February 1st 2007 at the Clinic for Ophtalmology, Military Medical Academy, Belgrade a total of 25 patients with esotropia (34 eyes) and previously corrected refraction anomaly and treated amblyopia were operated on. The patients were 4-19-year of age. All of the patients were submitted to a complete ophtalmologic and orthoptic examination prior to the surgery, and a month, three months and six months after the surgery. The surgery was performed under general anesthesia. Out of the total number of the patients nine were operated on both eyes, while 16 patients on one eye with amblyopia or frequent esodeviation. Nine patients were submitted to retroposition of the inner straight muscle, two to myectomy of the outer straight muscle, while in 14 of the patients a combination of retroposition and myectomy was performed. The patients were divided into three groups according to the preoperative angle at the distance and followed-up accordingly after the surgery. Deviation angle at the distance in the group I was 18-25 DP, in the group II 26-35 PD, while in the group III it was 36-60 PD. Results. The most numerous, group I (12 patients; 48%), a month following the surgery showed angle reduction by 55.58%, after three months 63.25%, and after six months 63.92%. The group II consisted of 8 patients (32%) showed angle reduction by 70.75% a month following the surgery, by 76% after three months, and by 79.12% after six months. The group III (5 patients; 20%) showed angle reduction by 72.20% a month following the surgery, 79.20 after three months, and 80.12% after six months following the surgery. Conclusion. The best postoperative outcomes after a month, three and six months were obtained in the group of patients with the highest esodeviation angle at the distance solved by the surgery on both eyes. Timely surgical treatment befell into major precondition for developing and maintaining the elements of binocular vision in the operated on patients. .

scholarly journals Regarding operative treatment of thoracoabdominal injuries

2019 ◽  
Vol 36 (1) ◽  
pp. 14-20
Author(s):  
Dmitriy G. Amarantov ◽  
Mikhail F. Zarivchatsky ◽  
Andrey A. Kholodar ◽  
Andrey S. Nagaev ◽  
Oleg S. Gudkov
Keyword(s):  
Operative Treatment ◽  
Clinical Situation ◽  
Rational Approach ◽  
Quality Of Treatment ◽  
Results Of Treatment ◽  
Group I ◽  
Thoracoabdominal Injuries ◽  
Group Ii

Aim. To improve the results of treatment in patients with thoracoabdominal injuries (TAI) by means of creating the method of determining indications for the use of classical or endoscopic surgeries in respect of this pathology. Materials and methods. Seventy-six sufferers from TAI were divided into 2 groups. Results. The method of successive determination of indications for the use of classical or endoscopic surgeries in patients with TAI was created on the basis of treatment of 41 (53.95 %) patients of group II. This method was used to treat 35 (46.05 %) patients of group I. Conclusions. Rational approach to the choice between the use of advantages of classical and endoscopic surgeries depending on characteristics of clinical situation permitted to elevate the quality of treatment in patients with TAI.

Hormonal status of patients after surgical treatment of fibrocystic mastopathy and possibilityes of its corrections

2017 ◽  
pp. 128-131
Author(s):  
Yu.Ya. Pryshash ◽  
Keyword(s):  
Surgical Treatment ◽  
Standard Dose ◽  
Treatment Phase ◽  
Nodule Formation ◽  
Double Dose ◽  
Postoperative Rehabilitation ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
High Doses

The purpose of the study was to investigate the efficacy of Mastodynon in terms of indications in elevated doses versus the standard dose. Materials and methods. Data were analyzed for 60 patients after surgical treatment of fibro-cystic mastopathy. Depending on the postoperative therapy received by the patients, they were divided into three groups. Group I (n = 20): patients were observed in accordance with the standards established in mammal practice and did not receive special agents that affect hormonal homeostasis. Group II (n = 20): In addition to observation, patients received Mastodynon® (1 tablet or 30 drops 2 times a day) for 6 months. Group III (n = 20): Patients were given for a post-operative rehabilitation Mastodynon® in a double dose (2 tablets or 60 drops 2 times a day) for 6 months. Results Surgical treatment without conservative therapy eliminates organic changes in the thoracic glands (GH), but hormonal disorders that have led to pathologic and histological changes in the tissues of GZ continue to exist for a long time and can lead to repeated nodal formations. In group І, 25% of patients within 2 years performed repeated sectoral resections on recurrence of nodule formation. In group І, 25% of patients within 2 years performed repeated sectoral resections on recurrence of nodule formation. The use of Mastodynon® in standard doses (group II) for postoperative rehabilitation contributes to a significant improvement in hormonal homeostasis (normalization of prolactin, estradiol and progesterone levels), a 24.7 mm decrease in the degree of cyclic mastodynia according to the visual analog scale (VAS), and the improvement of ultrasound scan Pictures of GZ in 75% of patients. The most pronounced effect of this rehabilitation approach after the surgical treatment phase was noted for the use of Mastodynone in doble doses (2 tablets or 60 drops 2 times a day) in Group III. In these patients, the degree of reduction of cyclic mastodynia was 30 mm for VAS and positive changes in the tissues of GH were noted in 85% of patients. However, the highest incidence of adverse events was also noted in Group III, although they were temporary in nature and did not require withdrawal or dose reduction. Conclusion. Despite the presence of short-term side effects and rapid rebounding in the double-dose Mastodynon® group, our study showed better results than standard doses, faster and more stable therapeutic effect. Taking into account the results obtained, it can be argued that the use of high doses of Mastodynon® may be recommended to patients for the treatment of mastopathy. For a more complete study of such an important aspect as the tolerability of high doses of Mastodynon®, it is advisable to conduct more extensive studies, taking into account the dosage form and the use of other drugs. Key words: mastopathy, postoperative rehabilitation, Mastodynon®, mastodynia.

Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

2021 ◽  
Author(s):  
Sonia B. Albanese Albanese
Keyword(s):  
Surgical Treatment ◽  
Pressure Gradient ◽  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Group I ◽  
Mean Pressure ◽  
Valve Function ◽  
Group Ii

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

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