Pulmonary valve stenosis: Difference between revisions

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List of terms related to Pulmonary valve stenosis

	Pulmonary valve stenosis;
	Pulmonary valve stenosis
ICD-10	I37.0, I37.2, Q22.1
ICD-9	424.3, 746.02
OMIM	265500
DiseasesDB	11025
MedlinePlus	001096
eMedicine	emerg/491

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Revision as of 20:14, 20 June 2011

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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For an expanded discussion of this topic see right ventricular outflow tract obstruction

Overview

Pulmonary valve stenosis is a valvular heart disease in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. This results in the reduction of flow of blood to the lungs.

Demographics and Epidemiology

Etiology

Anatomy

Diagnosis

Symptoms | Physical Examination | Echocardiography | Severity Assessment

Treatment

Valve replacement or surgical repair (depending upon whether the stenosis is in the valve or vessel) may be indicated.

External links

Overview at University of Maryland
Overview at American Heart Association
Pulmonary Stenosis information from Seattle Children's Hospital Heart Center

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@@ Line 24: / Line 24: @@
 '''Pulmonary valve stenosis''' is a [[valvular heart disease]] in which outflow of blood from the [[right ventricle]] of the [[heart]] is obstructed at the level of the [[pulmonic valve]]. This results in the reduction of flow of [[blood]] to the [[lungs]].
-==Demographics and Epidemiology==
+==[[Pulmonary stenosis epidemiology|Demographics and Epidemiology]]==
-*Generally, pulmonary valve stenosis is a congenital defect narrowing of the pulmonary valve (the semilunar valve that separates the right ventricule from the pulmonary artery), but occasionally, it could also be presented in adults as a complication of another illness.
-*It's one of the more common heart birth defects, and most cases are mild. If the pulmonary valve stenosis is moderate to severe, it will cause serious symptoms, requiring surgery which is highly successful.
+==[[Pulmonary stenosis Etiology and anatomy#etiology|Etiology]] ==
-*It occurs in about 1 of 10 children, and females are slightly more likely to be affected than males.
-== Etiology ==
+==[[Pulmonary stenosis Etiology and anatomy#Anatomy|Anatomy]] ==
-*Congenital pulmonic stenosis is most common.
-*Rheumatic involvement is rare, is usually part of  multivalvular involvement, rarely leads to serious deformity.
-*Carcinoid plaques can be present in the carcinoid syndrome. These result in constriction of the pulmonic valve ring, retraction and fusion of the valve cusps.
-== Anatomy ==
-*Typically the valve is domed shaped with fused commissures.
-*If the foramen ovale is patent, then right to left shunting can occur at the atrial level.
-*If there is pulmonary atresia with an intact ventricular septum then these patients die soon after birth.
 ==Diagnosis==
-===Symptoms===
+[[Pulmonary valve stenosis diagnosis#Symptoms|Symptoms]] | [[Pulmonary valve stenosis diagnosis#Physical Examination|Physical Examination]] | [[Pulmonary valve stenosis echocardiogram|Echocardiography]] | [[Pulmonary valve stenosis echocardiogram#Severity Assessment|Severity Assessment]]
-Symptoms include [[cyanosis]] (usually visible in the nailbeds), and general symptoms of [[hypoxemia]].  When the stenosis is mild, it can go unnoticed for many years. If stenosis is severe, [[dizziness]] or frank [[syncope]] may develop, particularly with exercise.
-===Physical Examination===
-====Neck====
-[[jugular venous distention]]
-==Echocardiography==
-=== 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 area<sub>RVOT</sub> * VTI<sub>RVOT</sub>)/ VTI<sub>PV</sub>
-* 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 ===
-{| border = 1
-|+ '''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
-|-
-|}
-* Pulmonic Stenosis 1
-<googlevideo>6761754875447006755&hl=en</googlevideo>
-* Pulmonic Stenosis 2
-<googlevideo>-5301172737736229119&hl=en</googlevideo>
-* Pulmonic Stenosis 3
-<googlevideo>-5141870933248575471&hl=en</googlevideo>
 ==Treatment==

v t e Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747)
Cardiac chambers and connections	Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo)
Cardiac septa	Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome
Right: pulmonary and tricuspid valves	pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly
Left: aortic and mitral valves	aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome
Other congenital malformations of heart	Dextrocardia - Levocardia - Cor triatriatum
Great arteries	aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia
Great veins	Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome
Other	Arteriovenous malformation (Cerebral arteriovenous malformation)
See also non-congenital conditions (I, 390-459)