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The mean peak systolic Doppler gradient was significantly reduced after surgery (Table 3; PAZD2281 clinical trial valve commissurotomy with/without biomembrane patch grafting in the nine dogs; however, one dog died perioperatively. All our cases showed type B pulmonary valvular stenosis, or were dogs weighing less than 3 kg. In such cases, it is considered difficult to completely palliate the pulmonary valve defect using balloon valvuloplasty and to insert a catheter into the stenotic region. We considered that surgery using CPB would be beneficial Quisinostat mouse and, therefore, proceeded directly to CPB in these dogs. Immediate and late success in pulmonary balloon valvuloplasty is defined as greater than 50% reduction in the pressure gradient from baseline, or a final pressure gradient below 80 mmHg (Bussadori and others 2001, Johnson and Martin 2004). In this study, there was an immediate average reduction of 60% in the pressure gradient following surgery. The reduced pressure gradient was maintained at least 6 months to 3 years after the operation. When cases of type B pulmonary valvular stenosis were considered separately, they showed an average reduction of 57��1% in the pressure gradient at 6 months to 3 years after operation. Balloon valvuloplasty is known to reduce 30 to 45% of the pressure Hesperadin gradient, and maintain this reduction for 6 months to 9 years (Ristic and others 2001, Johnson and others 2004). Depending on the type of valvular pulmonic stenosis, the median Doppler gradient is known to reduce from 115 to 45 mmHg (in type A pulmonary valvular stenosis) and from 132 to 72 mmHg (in type B pulmonary valvular stenosis) immediately (24 hours) after pulmonary balloon valvuloplasty. At 1 year after pulmonary balloon valvuloplasty, the median Doppler gradient in type A and B has been reported to be 50 mmHg (56��5% average reduction) and 86 mmHg (34��8% average reduction), respectively (Locatelli and others 2011). Our present findings revealed that surgical palliation of pulmonic stenosis under CPB was effective in type B pulmonary valvular stenosis and supravalvular stenosis, which are not suitable for treatment by balloon valvuloplasty.
