Tag Archives: Pulmonary Valve Stenosis

Pulmonary Valve Stenosis

Pulmonary valve stenosis, otherwise known as pulmonary or pulmonic stenosis, is a valve defect resulting in reduced flow in the pulmonary artery that carries deoxygenated blood from the heart to the lungs. This is generally a congenital condition characterized by a constricted pulmonary valve opening which regulates the blood flow.

Mild forms of this condition often go undetected in childhood due to lack of apparent symptoms, but a pronounced heart murmur in children often indicates severe pulmonary valve stenosis which requires surgical intervention.

In adults, angina or chest pain, shortness of breath, and bouts of fainting on exertion may point to a hitherto undiagnosed valve defect. When detected in adults, it can be often corrected through balloon valvuloplasty, an alternate option to valve replacement. A catheter is guided into the pulmonary valve and the three cusps that control it are separated by inflating the balloon at the tip of the catheter. Recently the pulmonary valve can be replaced using cardiac Cath.

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Congenital Pulmonary Valve Stenosis

When the pulmonary valve, which allows the blood in the right ventricle to pass into the pulmonary artery which leads to the lungs, is narrowed, it is referred to as pulmonary valve stenosis.

  • The stenosis affects the valve in the right ventricle which allows blood to be pumped out into the pulmonary artery that carries it to the lungs.
  • A heart murmur is the most common symptom, but in some cases, cyanosis may be present, and heart failure can occur.
  • The symptoms lead to diagnosis, which is confirmed by echocardiography.
  • The valve may be opened up by balloon valvuloplasty, but surgical reconstruction may be necessary in some cases.

Mild to moderate stenosis, which is more common, causes the right ventricle to work harder to get the blood pumped into the pulmonary artery through the narrowed valve opening. The blood is pumped at higher than normal pressure too. If the valve is severely narrowed, the right ventricle can pump out almost no blood into the lungs. Pressure builds up in the right ventricle, and when it becomes too high, the deoxygenated blood gets pumped through alternate pathways such as a septal defect in the atrial wall. This results in right-to-left shunting.

A heart murmur may be the only symptom displayed by most of the children who have congenital pulmonary valve stenosis. Cyanosis may be present in a few, and heart failure may occur in some. When the children grow older, fatigue and breathing difficulties may develop on exertion. Echocardiogram can confirm the condition, but sometimes, a procedure called cardiac catheterization is done to determine the severity and extent of stenosis.

Balloon valvuloplasty can successfully enlarge a valve with moderate stenosis, but if there are structural abnormalities, reconstructive surgery may be necessary. The fetal blood vessel ductus arteriosus is kept open with the administration of a prostaglandin drug like alprostadil, till surgical correction of the pulmonary valve can be done, or a an alternate route bypassing the valve can be created. This relieves severe cyanosis occurring due to pulmonary valve stenosis. When the infant grows older, surgery may have to be repeated.

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