Health Encyclopedia

Pulmonary valve stenosis

Definition

Pulmonary valve stenosis is a condition in which the flow of blood from the heart (right ventricle, or lower chamber) is blocked at the valve that separates the heart from the pulmonary artery (pulmonic valve). This narrowing is usually present at birth (congenital).

Alternative Names

Valvular pulmonary stenosis; Heart valve pulmonary stenosis

Causes, incidence, and risk factors

Pulmonary valve stenosis is most often caused by a malformation during fetal development. The cause is unknown, but genetics may play a role.

Narrowing that occurs in the pulmonary valve is called pulmonary valve stenosis. Narrowing that occurs below the pulmonary valve is called subvalvar pulmonary stenosis. Another form of the condition, supravalvar pulmonary stenosis, is when narrowing occurs above the main pulmonary valve.

The defect may occur alone, but is relatively common in connection with other heart defects. The condition can be mild or severe. It occurs rarely, in only about 10% of patients with congenital heart disease.

Pulmonary stenosis can also occur later in life as a result of conditions that cause damage or scarring of the heart valves. These include rheumatic fever, endocarditis, and other disorders.

Symptoms

Shortness of breath
Fatigue
Bluish coloration to the skin (cyanosis) in some patients
Chest pain
Fainting
Poor weight gain or failure to thrive in infants with severe blockage
Sudden death

Note: Patients with mild-to-moderate obstruction may not have any symptoms. There may be no symptoms until the disorder is severe. Symptoms, when present, may get worse with exercise or activity.

Signs and tests

A heart murmur may be heard by stethoscope. Tests used in the diagnosis of pulmonary stenosis may include:

Chest x-ray
ECG
Echocardiogram
Cardiac catheterization
MRI of the heart

Treatment

Sometimes, treatment may not be required.

Percutaneous balloon pulmonary dilation (valvuloplasty) using a catheter can be successful for the form of pulmonary valve stenosis that occurs without the presence of other heart defects.

Surgical repair of the defect may also be performed.

Medications used before surgery may include prostaglandins, water pills to remove the excess fluid, anti-arrhythmics to improve the heart function, and blood thinners to prevent clots.

Expectations (prognosis)

As a general rule with mild stenosis, one-third of patients get better, one-third stay the same, and one-third get worse. The outcome is good with successful surgery or cardiac catheterization. Other congenital heart defects may also be a factor.

Complications

Heart failure
Right ventricular hypertrophy (enlargement)
Cyanosis
Pulmonary regurgitation after repair
Death

Calling your health care provider

Call your health care provider if symptoms associated with pulmonary valve stenosis occur.

Call your health care provider if swelling (of the ankles or any area), difficulty breathing, or other new symptoms develop in a person with treated or untreated pulmonary valve stenosis.

References

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo; WB Saunders; 2007.

Review Date:12/10/2007
Reviewed By:David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; and Mark A Fogel, MD, FACC, FAAP, Associate Professor of Pediatrics and Radiology, Director of Cardiac MR, The Children's Hospital of Philadelphia.

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