Pulmonary valve stenosis
Pulmonic stenosis is a condition when flow of blood from the heart to the lungs slowing down due to deformation of the pulmonary valve that controls the blood flow.
In adults, this condition is often seen as a complication of another disease, but in most cases, pulmonary valve stenosis develops in the womb and is a congenital heart defect.
We select a narrow field physician to treat each specific cardiac disease, making the most effective treatment and helps to improve the quality of life of our patients.
Anat Birk, MD – specialist in pediatric cardiology. Director of Institute for the Heart Study, children Hospital Schneider
Raphael Hirsch, MD – specialist in congenital heart disease in adults, Director of congenital heart defects in adults, Department of Cardiology Beilinson Hospital
Prof. Ehud Raanani – specialist in cardiothoracic surgery and catheterization, Head of the Department of Cardiac Surgery, Chaim Sheba Medical Center,Tel Hashomer and Assuta Medical Center
Pulmonary stenosis may be mild, moderate and severe forms. Moderate pulmonary stenosis usually not deteriorate with time, but the average degree cases and severe cases may be worse, and often require surgical intervention.
Fortunately, due to Israeli technology and years of experience of our experts, the treatment of stenosis of the pulmonary valve is successful, and most patients born with this disease after surgery have a normal, usual life.
People with moderate pulmonary artery stenosis generally have no symptoms. Those with more significant stenosis often notice the first symptoms during physical exercise. It features such as: heart murmur (a whistling sound heard through a stethoscope caused by turbulent blood flow), shortness of breath, especially during the effort, chest pain, loss of consciousness (syncope), fatigue, heart palpitations.
Ask our experts if your child is experiencing shortness of breath, fainting, and chest pain.
If specialist finds pulmonary stenosis or other heart problems, timely diagnosis and prompt treatment can help reduce the risk of complications in the future.
Pulmonary stenosis usually occurs when the pulmonary valve is formed improperly in utero. At this point it is not known what causes abnormal development of the valve.
Normal pulmonary valve comprises three thin sections of tissue (leaves), arranged in a circle. With each heartbeat the valve opens in the direction of flow – from the pulmonary artery blood flow into the lungs – and then the valve closes to prevent back flow of blood into the right ventricle of the heart. When stenosis of the pulmonary valve, one or more flaps can be damaged or be thickened, or not properly disclosed. In this case, the valve is not functioning properly, limiting blood flow.
Sometimes pulmonary valve stenosis can cause other diseases:
Carcinoid syndrome. This syndrome is a combination of signs and symptoms, including redness and diarrhea. Carcinoid syndrome results in the release of chemical elements serotonin. Tumors called carcinoids localized in the digestive tract. In people with carcinoid syndrome can cause problems with the heart valve.
Rheumatism. This complication is infection caused by streptococcus bacteria, such as strep throat or scarlet fever. Rheumatism can cause damage to the heart valves.
Noonan syndrome. Genetic disease, which is also a risk factor for heart valves.
Mild to moderate pulmonary stenosis usually do not cause complications. Nevertheless, the stenosis may be associated with the following:
Infection. People with structural heart problems, such as pulmonary stenosis, are at increased risk of bacterial infection of the inner layer of the heart (endocarditis).
Impaired pumping function. As a result of severe stenosis of the pulmonary artery, the right ventricle of the heart becomes harder to pump blood into the pulmonary artery. Increased pressure causes a thickening of the heart muscle and the hypertrophy of the left ventricle. Eventually, the heart can become tough and rapidly weaken.
Heart failure. If the ventricles are relaxed they can not pump blood effectively, then develops a heart failure. This disease causes swelling of the legs and abdomen, as well as fatigue and shortness of breath.
Irregular heartbeat (cardiac arrhythmia, fibrillation). People with stenosis of the pulmonary artery are more likely to have irregular heartbeats. In marked stenosis irregular heartbeat associated with pulmonary stenosis usually is not life-threatening.
Diagnosis of pulmonary valve stenosis
Pulmonary stenosis is often diagnosed in childhood, but sometimes it is also found later in their lifetime. A doctor may suspect pulmonary stenosis, when he hears a heart murmur in the upper right corner of the patient’s chest during a routine check.
Before defining test specialist asks the patient questions along the following lines:
1. When you first develop symptoms?
2. Are the symptoms of prolonged or occur randomly and are short term in nature?
3. Emphasize whether symptoms during exercise? And when patsien is at rest in the supine position?
4. Have there been symptom improvement?
To confirm the diagnosis can be assigned to the following tests:
ECG. An electrocardiogram records the electrical activity of the heart at the time of its contraction. This test helps to determine whether the thickened muscle wall of the chambers of the heart (ventricular hypertrophy).
ECHO. Echocardiograms using high frequency sound waves to produce image of the heart. Sound waves produce moving images that can be viewed as a video on the screen. This test is necessary to study the structure of the pulmonary valve, the location and severity of stenosis and right ventricular function.
Magnetic resonance imaging and computed tomography. Sometimes used to confirm the diagnosis of pulmonary valve stenosis.
Catheterization (coronary angiography). During this procedure, specialist inserts a thin, flexible tube (catheter) into an artery or vein in the groin area and carries it to the heart. Contrast liquid injected through the catheter to be able to see blood vessels under the influence of X-rays. Doctors also use catheterization to measure blood pressure in the heart and blood vessels. This test is usually done only when specialist is suspecting that a patient may be necessary balloon valvuloplasty. Sometimes this procedure immediately goes into operation.
Treatment of pulmonary artery stenosis
Some cases of stenosis of the pulmonary artery is not complicated and does not require treatment. However, if the case is more serious can be carried out valvuloplasty (installation of the cylinder valve for expanding) or open heart surgery.
The decision to hold the balloon valvuloplasty or open surgery depends on the degree of blocking pulmonary valve. Pulmonary stenosis is classified as light, moderate or severe, depending on the measurement of the difference in blood pressure between the ventricle and the pulmonary artery.
Balloon angioplasty (valvuloplasty)
This method is generally the first choice for treatment using catheterization to treat pulmonary valve stenosis. During this procedure, surgeon inserts a thin tube through a vein in the leg and brings it to his heart. The balloon is placed into the damaged valve is inflated by opening the balloon, which increases the area available for flow. Then removed.
If necessary, balloon angioplasty can be performed during pregnancy.
Balloon angioplasty can not be applied in cases where the detected pulmonary stenosis of the pulmonary valve (supravalvular stenosis) or below the valve (subvalvular stenosis). This may require open heart surgery.
During surgery, the doctor fixes the valve, so that the blood could be easier. In some cases, surgeon may replace pulmonary valve.
Some people along with pulmonary stenosis have other congenital heart defects, which can also be adjusted during operation.
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