Pulmonary Stenosis Flashcards
What are the causes of pulmonary stenosis?
- Congenital
- Noonan’s syndrome
- Congenital rubella
- Carcinoid
- Obstructing tumours
- Infective endocarditis (bulky vegetation)
- Rheumatic heart disease (very rare)
What are the clinical signs of severe pulmonary stenosis?
- Raised JVP with giant a waves
- Left parasternal heave (right ventricular heave)
- Thrill in pulmonary area
- Widely split second heart sound
- Quiet P2
- Mid systolic crescendo-decrescendo murmur over pulmonary area +/- ejection click
- Signs of heart failure
What is Noonan’s syndrome?
Autosomal dominant condition in chromosome 12
Male phenotypic form of Turner’s syndrome, but with normal karyotype
Right sided cardiac lesions including pulmonary stenosis, ASD, VSD
How would you investigate a patient with pulmonary stenosis?
ECG
- RVH
- RAH
- RAD
CXR
- Post-stenotic dilation of main PA
- Diminished pulmonary vascular markings
- Apex lifted off left hemidiaphragm
TTE: pulmonary valve peak systolic gradient, Doppler jet velocity
- Mild: < 36mmHg ( <3m/s)
- Moderate: 36-64mmHg (3-4m/s)
- Severe: > 64mmHg (>4m/s)
TEE - delineate RV outflow tract, infundibular hypertrophy
How would you manage a patient with pulmonary stenosis?
Endocarditis prophylaxis
Mild: often require follow-up only
Moderate: follow-up
Severe: valvuloplasty, valve repair or valve replacement
How would you grade the severity of pulmonary stenosis?
Trans-valvular gradient
Mild: <50mmHg
Moderate: 50-79mmHg
Severe:>80mmHg