From the Guidelines
Pulmonary valve stenosis is a condition that presents with symptoms such as shortness of breath, chest pain, fatigue, heart palpitations, and fainting during physical activity, and its treatment depends on the severity of the stenosis, with balloon valvuloplasty being the preferred treatment for moderate to severe cases, as recommended by the 2019 AHA/ACC guideline 1. The symptoms of pulmonary valve stenosis vary based on the severity of the condition, and may include:
- Shortness of breath
- Chest pain
- Fatigue
- Heart palpitations
- Fainting during physical activity In infants, poor feeding, failure to thrive, and cyanosis (bluish skin) may occur in severe cases.
Treatment Options
The treatment of pulmonary valve stenosis depends on the severity of the condition, and may include:
- Regular monitoring for mild cases
- Balloon valvuloplasty for moderate to severe cases, which is a safe and effective procedure in reducing the pulmonary valve gradient and improving symptoms in most patients, as stated in the 2019 AHA/ACC guideline 1
- Surgical options, such as pulmonary valve replacement or valvotomy, for cases where balloon valvuloplasty is not effective or for patients with severe pulmonary stenosis and associated hypoplastic pulmonary annulus, severe pulmonary regurgitation, subvalvular PS, or supravalvular PS, as recommended by the 2019 AHA/ACC guideline 1 Medications may be used to manage symptoms, such as beta-blockers to control heart rate and diuretics to reduce fluid buildup, but are not typically used to treat the stenosis itself.
Importance of Intervention
Relief of a severely stenotic pulmonary valve, even in asymptomatic patients, can reduce the RV pressure and the possibility of potential sequelae, and can be performed by surgery or interventional catheterization with low morbidity and mortality, as stated in the 2019 AHA/ACC guideline 1. It is essential to note that the condition requires lifelong cardiac follow-up, with frequency determined by severity, and that antibiotics may be prescribed before certain dental or surgical procedures to prevent endocarditis in at-risk patients.
From the Research
Symptoms of Pulmonary Valve Stenosis
- Symptoms of pulmonary valve stenosis may include exertional dyspnea, as observed in a 59-year-old female with isolated, severe PVS 2
- Elevated plasma BNP concentration may also be present, as seen in the same case study 2
- Other symptoms may be related to the severity of the stenosis and the presence of associated anomalies, such as valvular dysplasia or small diameter of the ring 3
Treatment Options for Pulmonary Valve Stenosis
- Balloon pulmonary valvuloplasty (BPV) is the preferred therapy for pulmonary valve stenosis, as it provides immediate relief of pulmonary valve obstruction 4, 5, 3, 6
- The use of an hourglass-shaped balloon, such as the V8 Aortic Valvuloplasty Balloon, may be an effective alternative for patients with large pulmonary annular diameters 4
- Pulmonary valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, and transcatheter pulmonic valve replacement is a rapidly evolving field with promising short and mid-term results 5
- The balloon:annulus ratio is an important factor in determining the success of BPV, with a ratio of approximately 1.2 providing the most optimal results 5, 6
Follow-Up and Monitoring
- Cardiac magnetic resonance imaging (cMRI) in combination with echocardiography may be a useful tool for follow-up and monitoring of patients with pulmonary valve stenosis after BPV 2
- cMRI can provide comprehensive evaluation of cardiac structure and function, and may help to identify potential complications or recurrence of stenosis 2