What is pulmonary valve stenosis?
Pulmonary stenosis is the thickening, narrowing, and stiffening of the pulmonary valve.
To understand pulmonary valve stenosis, we must first understand how the pulmonary valves function. The pulmonary valve lies between the lower right chamber of the heart (right ventricle) and the pulmonary artery (artery that carries blood to the lungs). They open to allow blood to flow to the lungs and then close quickly to prevent blood from flowing backwards.
With pulmonary stenosis, the pulmonary valve becomes too narrow, too small and cannot open completely. It puts extra pressure on the right ventricle to pump blood to the lungs. This excess pressure can cause the right ventricle to thicken, making it difficult for the heart to pump blood.
What are the most common signs and symptoms of pulmonary valve stenosis?
The symptoms of pulmonary valve stenosis depend on the degree of narrowing and stiffening of the pulmonary valve. Many people with stricture may not have symptoms. Some may have mild symptoms that do not cause discomfort. The most common sign of pulmonary stenosis is a distinct heart murmur (noise) that a cardiologist can hear during a chest exam with a stethoscope.
Some of the most common symptoms of severe pulmonary valve stenosis are:
- Cyanosis (a bluish tinge to the skin) in newborns. Cyanosis is caused by a decreased level of oxygen in the blood
- Fatigue and malaise
- Bad weight gain
- Difficulty and shortness of breath
- Palpitations (feeling like an irregular heartbeat)
- Chest pain
- Loss of appetite or bad food
What are the most common causes of pulmonary stenosis?
In most patients, pulmonary valve stenosis is a congenital defect, meaning a baby is born with it.
In these cases, pulmonary stenosis occurs due to impaired development of the baby’s heart during pregnancy. Doctors may not know the exact cause of this heart development problem.
Pulmonary stenosis can also occur in adults as a complication of various diseases of the heart. Conditions like rheumatic fever and carcinoid tumors in the digestive system can have pulmonary stenosis as one of the complications.
What are the possible complications of untreated pulmonary valve stenosis?
Untreated severe cases of pulmonary valve stenosis can lead to several complications.
Some of them are:
- Right ventricular hypertrophy (enlargement): It becomes weak and can cause permanent heart damage.
- Irregular heartbeat or arrhythmia
- Cyanosis: A reduced supply of oxygen-rich blood to your tissues can lead to a bluish discoloration of the skin
- Heart infection or endocarditis
- Untreated pulmonary valve stenosis makes your heart work harder to pump blood to the lungs, which can lead to heart failure and death.
How can doctors diagnose pulmonary valve stenosis?
A doctor can diagnose pulmonary stenosis before or after giving birth.
Before giving birth, a doctor can determine pulmonary stenosis with a fetal echocardiogram (echo). A fetal echo uses sound waves to create a moving image of the unborn baby’s heart. This helps a doctor determine the anatomy and physiology of a baby’s heart while it is still in the womb.
After giving birth, the first sign of pulmonary stenosis is a heart murmur. When examining with a stethoscope, a doctor may hear an additional click, rustle, bubble, or hiss.
To further confirm the diagnosis, the doctor may recommend several tests to see if there is a narrowing or stiffening of the pulmonary valve, or if the blood is draining freely. These tests are
- Chest x-ray
- MRI examination
Does pulmonary stenosis always require treatment?
Treatment for pulmonary stenosis depends on a number of factors, which include, but are not limited to
- Location of the defect
- Size of the defect
- Age of the patient
- Structural and functional integrity of other heart valves
- History of heart surgery
- Presence of other diseases
If the stenosis is asymptomatic or has very mild symptoms, treatment may not be required.
In some cases, a cardiologist may prescribe some medications to help relieve symptoms. Some of these drugs are:
- Prostaglandins: to improve blood circulation
- Blood thinners: to reduce clotting
- Antiarrhythmia pills: to prevent irregular heart rhythm
For patients with severe pulmonary stenosis, a doctor may recommend surgery to repair or replace the valve.
The procedures for treating pulmonary stenosis are:
- Balloon valvuloplasty: A doctor inserts a catheter into the heart and threads a balloon through the valve of the lung. This balloon inflates and stretches the wall of the heart.
- Valve replacement with a mechanical or a biological valve.
Dr. Dhananjay RS | Specialist – Cardiology – Adults, Cardiology – Pediatrics | SS Narayana Heart Center, Davangere
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