Pulmonary stenosis

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Pulmonary stenosis occurs when there is obstruction to the outflow from the right ventricle This results in the reduction of flow of blood to the lungs. In 80% of the cases, the obstruction is at the pulmonary valve level.

Contents

Aetiology

  • Congenital
isolated
as part of other congenital heart defects including Transposition of Great arteries or Tetrology of Fallot
other syndromes including Noonan's syndrome.
  • Rheumatic heart disease (rare)
  • Malignant Carcinoid

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
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