Pulmonary stenosis

pulmonary-stenosis-01 pulmonic-stenosis

This is usually congenital when it is isolated or associated with other abnormalities such as Fallot’s tetralogy but may result from rheumatic fever or from the carcinoid syndrome.

Clinical features:

Symptoms:

  1. Symptoms of right heart failure.
  2. Symptoms of the carcinoid syndrome.

Signs:

  1. Giant a wave in the JVP.
  2. RV hypertrophy and dilatation.
  3. Systolic murmur (Upper left sternum).
  4. Systolic thrill over pulmonary outflow.
  5. Soft and delayed.
  6. Valvular SP may have an ejection click.

Investigations:

  1. Chest X-ray: prominent pulmonary artery.
  2. ECG: Right atrial and RV hypertrophy.
  3. Echo: Abnormal PV, outflow gradient on Doppler.

Management:

  1. Mild to moderate isolated pulmonary stenosis does not required treatment because it does not usually progress.
  2. Severe pulmonary stenosis (resting gradient > 50 mm hg with a normal cardiac output) is treated by-
  • Percutaneous pulmonary balloon valvuloplasty, or
  • Surgical pulmonary valvotomy.

Reference:

  1. Davidson’s Principles and Practice of Medicine, 21st edition.
  2. Wikipedia the free encyclopedia.

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