Dynamics of Valvular Pulmonic Stenosis Studied by Needle Puncture of Pulmonary Artery and Right Ventricle on the Operating Table

¹ From the Department of Medicine, Division of Cardiology, The Mount Sinai Hospital, New York City

In 10 patients with valvular pulmonic stenosis and normal aortic root, simultaneous equisensitive pressure-pulses were obtained by needle puncture of the exposed heart before and after transventricular valvulotomy. The right ventricular and pulmonary artery pulses thus recorded were analyzed in terms of absolute pressures, relationship of electrical to mechanical events, duration of the phases of the cardiac cycle and contour characteristics. The cardiac cycle in valvular pulmonic stenosis was found to differ from the normal principally by the marked abbreviation or complete absence of the phases of isometric contraction and relaxation. The right ventricle contracts in an abnormal manner, with a sharply peaked pressure pulse contour. The pulmonary artery curve is characterized by an early systolic dip, analogous to the anacrotic notch of aortic stenosis. In some cases, the immediate drop in right ventricular-pulmonary artery systolic pressure gradient achieved by valvulotomy may not indicate the total reduction which will occur with time. This method of pressure pulse analysis has been found safe and appears free of artefacts introduced by the presence of the cardiac catheter.