Pulmonary valve stenosis: what are its symptoms, causes and treatment

Pulmonary valve stenosis is a narrowing of the valve between the lower right chamber of the heart (right ventricle) and the pulmonary arteries. In a narrowed heart valve, the valve leaflets (cusps) may become thick or stiff. This results in reduced blood flow through the valve.

Pulmonary valve diseases are usually the result of a heart problem that developed before birth (congenital heart defect). However, adults can develop pulmonary valve stenosis as a complication of another disease.

Pulmonary valve stenosis can be mild to severe. Some people with pulmonary valve stenosis do not notice any symptoms and only require occasional medical examinations. Moderate and severe pulmonary valve stenosis may require surgery to repair or replace the valve.

The signs and symptoms of pulmonary valve stenosis vary depending on the amount of obstructed blood flow. Some people with mild pulmonary stenosis have no symptoms. Those with more severe pulmonary stenosis may first notice symptoms when exercising.

Signs and symptoms of pulmonary valve stenosis may include:

A whistling sound (whispering) that can be heard with a stethoscope Fatigue Shortness of breath, especially during activity Chest pain Loss of consciousness (fainting)

The skin of babies with pulmonary valve stenosis and other congenital heart defects may turn blue (cyanosis).

Tell your doctor if you or your child have:

Shortness of breath Chest pain Fainting

If you or your child have pulmonary stenosis or another heart problem, prompt diagnosis and treatment can help reduce your risk of complications.

Conditions or disorders that may increase the risk of pulmonary valve stenosis include:

German measles (Rubella).

Having German measles (rubella) during pregnancy increases the risk of the baby having pulmonary valve stenosis.

Noonan Syndrome.

This genetic disease causes various problems with the structure and function of the heart.

Acute articular rhumatism.

This complication of strep throat can cause permanent damage to the heart, including heart valves. This can increase the risk of later developing pulmonary valve stenosis.

carcinoid syndrome.

It is a rare cancerous growth that releases certain chemicals into the blood, causing shortness of breath, flushing, and other signs and symptoms. Some people with this syndrome develop carcinoid heart disease, which damages the heart valves.

Pulmonary valve stenosis is often diagnosed in childhood. However, it may not be detected until later in life.

The doctor will use a stethoscope to listen to your or your child’s heart. You may hear a hissing sound (murmur) caused by restless (turbulent) blood flow through the narrowed valve.

Tests to diagnose pulmonary valve stenosis may include:

Electrocardiogram.

This quick and painless test records electrical signals from the heart. Adhesive patches (electrodes) are placed on the chest and sometimes on the arms and legs. Cables connect the electrodes to a computer which displays the results. A

electrocardiogram

it can show how the heart is beating and can reveal signs of thickening of the heart muscle.

Echocardiogram.

An echocardiogram uses sound waves to produce pictures of the heart. This common test allows a doctor to see how the heart is beating and pumping blood. An echocardiogram can show the structure of the pulmonary valve as well as the location and severity of its narrowing.

Cardiac catheterization. A thin tube (catheter) is inserted into the groin and threaded through the blood vessels to the heart. Through the catheter, a dye can be injected into your blood vessels so that they can be seen better on x-rays (coronary angiography).

Doctors also use cardiac catheterization to measure the pressure inside the chambers of the heart to see how hard the heart is pumping blood. If you have been diagnosed with pulmonary valve stenosis, your doctor can determine the severity of the condition by comparing the difference in blood pressure between the lower right chamber of the heart and the pulmonary artery.

Other imaging tests.

Magnetic resonance imaging and computed tomography are sometimes used to confirm a diagnosis of pulmonary valve stenosis.

If you have mild pulmonary valve stenosis without symptoms, you may only need occasional checkups with your doctor.

If you have moderate to severe pulmonary valve stenosis, you may need cardiac intervention or surgery. The type of procedure or surgery you have will depend on your general health and the appearance of your pulmonary valve.

Cardiac procedures and surgeries used to treat pulmonary valve stenosis include the following:

Balloon valvuloplasty. The doctor inserts a flexible tube (catheter) with a balloon on the end into an artery, usually in the groin. X-rays are used to help guide the catheter into the narrowed heart valve. The doctor inflates the balloon, which enlarges the opening of the valve and spreads the leaflets if necessary. The balloon deflates. The catheter and balloon are removed.

Valvuloplasty can improve blood flow in the heart and reduce symptoms of pulmonary valve stenosis. However, the valve may narrow again. Some people need valve repair or replacement in the future.

Pulmonary valve replacement. If balloon valvuloplasty is not an option, open-heart surgery or catheterization may be done to replace the pulmonary valve. If there are other congenital heart defects, the doctor can fix them during the same surgery.

People who have had pulmonary valve replacement should take antibiotics before certain dental or surgical procedures to prevent endocarditis.

Treatment for pulmonary valve stenosis may include:

Balloon valvuloplasty. The provider inserts a flexible tube with a balloon on the end into an artery, usually in the groin. The x-rays help guide the tube, called a catheter, to the narrowed heart valve. The balloon inflates, enlarging the opening of the valve. The balloon is deflated. The catheter and balloon are removed.

Valvuloplasty can improve blood flow in the heart and reduce symptoms of pulmonary valve stenosis. But the valve can narrow again. Some people need valve repair or replacement in the future.

Pulmonary valve replacement. If balloon valvuloplasty is not an option, open-heart surgery or a catheter procedure may be performed to replace the pulmonary valve. If there are other heart problems, the surgeon can fix them during the same surgery.

People who have had pulmonary valve replacement should take antibiotics before certain dental or surgical procedures to prevent endocarditis.