Pulmonary Stenosis

Introduction 

Pulmonic stenosis is a valvular abnormality that obstructs blood flow between the right ventricle and the pulmonary arteries 

Risk factors: German measles, rheumatic fever, Noonan sy1ndrome, carcinoid syndrome 

Untreated severe stenosis may result in RV failure 

Symptoms & Signs 

-mild cases are asymptomatic 

-moderate to severe cases may cause dyspnea on exertion, syncope, chest pain, RV failure

-cyanosis and clubbing if parent foramen ovale or ASD exists 

-a loud, harsh, high pitched systolic ejection murmur, a prominent thrill present in the left second and third interspaces parasternally

-the murmur radiates toward the left shoulder and increases with inspiration 

-this is the only right-sided auscultatory event that decreases with inspiration 

-a loud ejection click can be heard to precede the murmur

-the pulmonary component of S2 may be diminished, delayed, or absent

-Noonan syndrome: short stature, web neck, mental retardation, antimongoloid slanting of the eyes, hypogonadism 

Diagnosis 

ECG: right ventricular hypertrophy with right-axis deviation, prominent R waves in the right precordial leads

Chest radiography: dilated main and left pulmonary arteries, post-stenotic dilatation; greater vascular perfusion of the left lung than the right base (Chen sign)

Echocardiography: diagnostic tool of choice

Treatment 

-Percutaneous balloon valvuloplasty, Surgical commissurotomy or pulmonary valve replacement

-Endocarditis prophylaxis in certain cases 

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