Pulmonary Stenosis

Congenital is common, may be valvular, subvalvular, supravalvular or infundibular.

Acquired is rare, usually mild and associated with other valve lesions.

Carcinoid.

Pulmonary Stenosis

Symptoms of Pulmonary Stenosis

• Abdominal distention
• Bluish color to the skin (cyanosis) in some patients
• Fainting
• Fatigue
• Poor weight gain or failure to thrive in infants with severe blockage
• Shortness of breath

Signs

Prominent a wave in Jugular Venous Pulse

Right Ventricular lift

Pulmonary ejection click (only in Valvular PS)

Harsh loud midsystolic ejection murmur in second left intercostals space, associated with thrill, radiating to left shoulder, murmur increases with inspiration but the click decreases.

Examinations for Pulmonary Stenosis

Pulmonary oligemia

Post stenotic dilatation of pulmonary artery (in valvular PulmonaryStenosis)

X Ray

ECG

Right atrial enlargement

Right ventricular hypertrophy

RV1 correlates better with degree of Pulmonary Stenosis.

ECG

Echocardiography

Doming of pulmonary valve during systole

Right Ventricular hypertrophy

Dilated pulmonary artery

Echo

Doppler detection of gradient

Pulmonary Stenosis

Treatment for Pulmonary Stenosis

Gradient exceeding 30 mmhg needs Balloon valvoplasty or Valvotomy with / without enlargement of annulus

Conduit in severe stenosis

Surgical Repair

Causes of Pulmonary Oligaemia

Pulmonic valvular stenosis

Pulmonary atresia

Primary pulmonary hypertension (peripheral oligaemia)

Pulmonary embolism (Massive)

Prognosis

Patients with mild disease rarely get worse. However, those with moderate to severe disease will get worse. The outcome is good with successful surgery or balloon dilation. Other congenital heart defects may be a factor in the outlook.

Most often, the new valves can last for decades. Others wear out and will need to be replaced.