RT Journal Article SR Electronic T1 The unnatural history of pulmonary stenosis up to 40 years after surgical repair JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 273 OP 279 DO 10.1136/heartjnl-2015-309159 VO 103 IS 4 A1 Judith A AE Cuypers A1 Myrthe E Menting A1 Petra Opić A1 Elisabeth M WJ Utens A1 Willem A Helbing A1 Maarten Witsenburg A1 Annemien E van den Bosch A1 Ron T van Domburg A1 Sara J Baart A1 Eric Boersma A1 Folkert J Meijboom A1 Ad J JC Bogers A1 Jolien W Roos-Hesselink YR 2017 UL http://heart.bmj.com/content/103/4/273.abstract AB Objective To provide prospective information on long-term outcome after surgical correction of valvular pulmonary stenosis (PS).Methods Fifty-three consecutive patients operated for PS during childhood between 1968 and 1980 in one centre are followed longitudinally for 37±3.4 years, including extensive in-hospital examination every 10 years.Results Survival information was available in 100% of the original 53 patients. Cumulative survival was 94% at 20 years and 91% at 40 years. Excluding perioperative mortality (<30 days), survival was 94% at 40 years. Of 46 eligible survivors, 29 participated in the in-hospital examination and 15 gave permission to use their hospital records (96% participation). Cumulative event-free survival was 68% after 40 years: 25% needed a reintervention, 12% underwent pacemaker implantation and 9% had supraventricular arrhythmias. Early reinterventions were mainly for residual PS, late reinterventions for pulmonary regurgitation. Subjective health status was good. Exercise capacity was normal in 74% (median 96 (82–107)% of expected workload). Right ventricular and left ventricular (LV) dysfunction was found in 13% and 41%, respectively. The use of a transannular patch and younger age at surgery were predictive for late events (HR 3.02 (95% CI 1.09 to 8.37) and HR 0.81/year (95% CI 0.66 to 0.98), respectively). Use of inflow occlusion compared with cardiopulmonary bypass showed a trend towards more reinterventions (HR 3.19 (95% CI 0.97 to 10.47)).Conclusions Survival up to 40 years after successful PS repair is nearly normal. Subjective health status is good and there is a low incidence of arrhythmias. Reinterventions, however, are necessary in one-quarter and 40 years postoperatively several patients show LV dysfunction.