What are the Technique of Operation in CPS?
Percutaneous balloon valvotomy is the procedure of choice at any age. If this is not feasible, open surgical valvotomy is recommended. This is usually done under cardio pulmonary bypass.
The approach is through a median sternotomy and institution of cardio pulmonary bypass with ascending aortic and bicaval cannulation. Moderate hypothermia to 28OC and cardioplegia are used. Pulmonary trunk is opened vertically and valve inspected. All the Three commissures are incised up to the annulus. Adherent commissures are separated from pulmonary arterial wall and incised. When the cusps are thick and obstructive, valvectomy is also performed to give better opening. In case there is infundibular narrowing it can be excised from right atrium, pulmonary artery or by ventriculotomy. Pulmonary annular narrowing is treated by transannular patching with pericardium or PTFE patch. Systemic- pulmonary shunting is done if the right ventricle is hypoplastic.