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Pulmonary Stenosis

Pulmonary Stenosis

Pulmonary Stenosis is a heart valve disorder that involves the pulmonary valve.This valve separates the right ventricle (one of the chambers in the heart) and the pulmonary artery. The pulmonary artery carries oxygen-poor blood to the lungs.Stenosis, or narrowing, occurs when the valve cannot open wide enough. As a result, less blood flows to the lungs.

Congenital is common, may be valvular, subvalvular, supravalvular or infundibular.

Acquired is rare, usually mild and associated with other valve lesions.


Pulmonary Stenosis

Pulmonary Stenosis

Symptoms of Pulmonary Stenosis

  • Abdominal distention
  • Bluish color to the skin (cyanosis) in some patients
  • Fainting
  • Fatigue
  • Poor weight gain or failure to thrive in infants with severe blockage
  • Shortness of breath


Prominent a wave in Jugular Venous Pulse

Right Ventricular lift

Pulmonary ejection click (only in Valvular PS)

Harsh loud midsystolic ejection murmur in second left intercostals space, associated with thrill, radiating to left shoulder, murmur increases with inspiration but the click decreases.

Examinations for Pulmonary Stenosis

Pulmonary oligemia

Post stenotic dilatation of pulmonary artery (in valvular PulmonaryStenosis)

Pulmonary Stenosis

X Ray


Right atrial enlargement

Right ventricular hypertrophy

RV1 correlates better with degree of Pulmonary Stenosis.

Pulmonary Stenosis



Doming of pulmonary valve during systole

Right Ventricular hypertrophy

Dilated pulmonary artery

Pulmonary Stenosis


Doppler detection of gradient

Pulmonary Stenosis

Pulmonary Stenosis

Treatment for Pulmonary Stenosis

Gradient exceeding 30 mmhg needs Balloon valvoplasty or Valvotomy with / without enlargement of annulus

Conduit in severe stenosis

Pulmonary Stenosis

Surgical Repair

Causes of Pulmonary Oligaemia

Pulmonic valvular stenosis

Pulmonary atresia

Primary pulmonary hypertension (peripheral oligaemia)

Pulmonary embolism (Massive)


Patients with mild disease rarely get worse. However, those with moderate to severe disease will get worse. The outcome is good with successful surgery or balloon dilation. Other congenital heart defects may be a factor in the outlook.

Most often, the new valves can last for decades. Others wear out and will need to be replaced.

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