Assessment of residual right ventricular outflow tract obstruction following surgery using the response to intravenous propranolol

Ann Thorac Surg. 1987 Dec;44(6):633-6. doi: 10.1016/s0003-4975(10)62151-0.


The response to intravenous administration of propranolol hydrochloride was studied in 24 children undergoing operation for isolated or complex right ventricular outflow tract obstruction. Ten had pulmonary valve stenosis, 4 had pulmonary valve stenosis plus ventricular septal defect, 8 had tetralogy of Fallot, and 2 had complex lesions. Propranolol (0.01 to 0.2 mg per kilogram of body weight) was given to patients with a residual right ventricular to left ventricular systolic pressure ratio greater than 0.75. Four children did not respond to propranolol and required further surgical intervention. Twenty patients responded, 2 of whom died. Fifteen were restudied by cardiac catheterization 3 weeks to 27 months postoperatively. The right ventricle-pulmonary artery gradient was 25 mm Hg or less in 13 patients. We conclude that a small dose of propranolol given intraoperatively can identify patients in whom a reduction in the right ventricle-pulmonary artery gradient to acceptable levels will occur in the months following operation. This may reduce the need for placement of a subannular or transannular patch in some patients.

MeSH terms

  • Blood Pressure / drug effects
  • Cardiac Catheterization
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Heart Septal Defects, Ventricular / diagnosis*
  • Heart Septal Defects, Ventricular / physiopathology
  • Heart Septal Defects, Ventricular / surgery
  • Heart Ventricles / drug effects
  • Heart Ventricles / physiopathology
  • Humans
  • Postoperative Period
  • Propranolol* / administration & dosage
  • Pulmonary Valve Stenosis / diagnosis*
  • Pulmonary Valve Stenosis / physiopathology
  • Pulmonary Valve Stenosis / surgery
  • Reoperation
  • Tetralogy of Fallot / diagnosis*
  • Tetralogy of Fallot / physiopathology
  • Tetralogy of Fallot / surgery


  • Propranolol