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.