Pulmonic stenosis is a valvulopathy due to the pulmonic valve obstructing blood flow from the right ventricle to the pulmonary artery, presenting with similar symptoms to aortic stenosis. It is diagnosed with echocardiography and treated with balloon valvuloplasty if disease is severe.
Pathophysiology
- Often congenital
- Seen in tetralogy of Fallot
- Can also be due to carcinoid syndrome in adults
Contextual Factors
- Tetralogy of Fallot
Clinical Manifestation
- Asymptomatic in most cases
- Can have aortic stenosis symptoms:
- Syncope
- Angina
- Dyspnea
Cardiac
Auscultation
- Widened S2 splitting due to delayed P2
- Harsh crescendo-decrescendo systolic murmur
- Dose not radiate to the carotid arteries
Complications
- Right heart failure
Diagnosis
- Echocardiography
| Severity | Peak Gradient (mmHg) | Peak Velocity (m/s) |
|---|---|---|
| Mild | < 36 | < 3 |
| Moderate | 36 - 64 | 3 - 4 |
| Severity | > 64 | > 4 |
- ECG: RV hypertrophy or right bundle branch block
Treatment
- Most cases will improve without intervention
- Balloon valvuloplasty can be done for moderate or severe stenosis