Surgical management is indicated when balloon valvotomy is not feasible, has failed, or when the anatomy or associated pathology makes catheter-based relief inadequate.
The intervention is surgical relief of the pulmonary obstruction. The specific operative technique depends on the underlying anatomy — cases involving a hypoplastic annulus or dysplastic valves require a more extensive repair, while sub-valvular and supravalvular forms are also addressed surgically. The complete operative protocol, decision criteria, and approach details are available in the full structured regimen.
Otherwise, surgical repair is recommended in case of symptomatic patients with moderate or severe valvular pulmonic stenosis who are ineligible for balloon valvotomy or who have failed it.
This includes patients with severe PS and an associated hypoplastic pulmonary annulus, severe pulmonary regurgitation (PR), sub-valvular PS or supravalvular pulmonic stenosis.
Surgery is also preferred for most dysplastic valves and when there is associated severe tricuspid regurgitation or other cardiopathy that warrants operative intervention.
In these patients, surgical repair is required to excise thickened and obstructive valve leaflets and place a transannular patch.
Surgery is also the intervention of choice for patients with sub-valvular and supravalvular PS.
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