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For an expanded discussion of this topic see right ventricular outflow tract obstruction
Overview
Pulmonary valve stenosis is a valvular heart disease in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. This results in the reduction of flow of blood to the lungs.
Diagnosis
Symptoms
Symptoms include cyanosis (usually visible in the nailbeds), and general symptoms of hypoxemia. When the stenosis is mild, it can go unnoticed for many years. If stenosis is severe, dizziness or frank syncope may develop, particularly with exercise.
Physical Examination
Neck
jugular venous distention
Echocardiography
2D echocardiography
- Thickened leaflets with systolic bowing in valvular stenosis.
- Difficult to distinguish between valvular, sub valvular and supra valvular stenosis with 2D echocardiography.
- Post stenotic pulmonary artery dilatation can be visualised sometimes.
Doppler echocardiography
- Ante grade velocity increased with corresponding maximum and mean pressure gradients.
- Pulmonary valve area can be calculated using the continuity equation.
- Pulmonary Valve Area = (Cross sectional areaRVOT * VTIRVOT)/ VTIPV
- The site of obstruction can be difficult to diagnose by 2D echo. Cautious use of colour flow mapping and PW Doppler can pin point the location of obstruction.
Severity Assessment
Severity of pulmonic stenosis
| Severity | mild | moderate | severe
|
| Valve area | >1.0 | 1- 0.5 | <0.5
|
| Peak gradient (mm Hg) | <10-25 | 25-40 | >40
|
Treatment
Valve replacement or surgical repair (depending upon whether the stenosis is in the valve or vessel) may be indicated.
External links
| Circulatory system pathology (I, 390-459) |
|---|
| Hypertension | Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension) |
|---|
| Ischaemic heart disease | Angina pectoris (Prinzmetal's angina) - Myocardial infarction (heart attack) - Dressler's syndrome |
|---|
| Pulmonary circulation | Pulmonary embolism - Cor pulmonale |
|---|
| Pericardium | Pericarditis - Pericardial effusion - Cardiac tamponade |
|---|
| Endocardium/heart valves | Endocarditis - mitral valve (regurgitation, prolapse, stenosis) - aortic valve (stenosis, insufficiency) - pulmonary valve (stenosis, insufficiency) - tricuspid valve (stenosis, insufficiency) |
|---|
| Myocardium | Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia |
|---|
Electrical conduction system
of the heart | Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block
Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death
Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation (Familial) - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome |
|---|
| Other heart conditions | Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right) |
|---|
| Cerebrovascular diseases | Stroke - Transient ischemic attack - Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage)
Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease |
|---|
Arteries, arterioles
and capillaries | Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma - Dissection (Carotid artery, Vertebral artery) |
|---|
Veins, lymphatic vessels
and lymph nodes | Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis) |
|---|
| Other | Hypotension (Orthostatic hypotension) - Rheumatic fever |
|---|
| See also congenital (Q20-Q28, 745-747) |
| Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747) |
|---|
| Cardiac chambers and connections | Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo) |
|---|
| Cardiac septa | Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome |
|---|
| Right: pulmonary and tricuspid valves | pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly |
|---|
| Left: aortic and mitral valves | aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome |
|---|
Other congenital malformations
of heart | Dextrocardia - Levocardia - Cor triatriatum |
|---|
| Great arteries | aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia |
|---|
| Great veins | Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome |
|---|
| Other | Arteriovenous malformation (Cerebral arteriovenous malformation) |
|---|
| See also non-congenital conditions (I, 390-459) |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
