Pulmonary valve stenosis

The collective term pulmonary stenosis multiple stenoses in the outflow tract of the right ventricle to the pulmonary artery to be understood. The pulmonary valve is designed with three pockets.

  • The infundibular pulmonary stenosis in the lower muscular outflow tract
  • Valvular pulmonary stenosis the ( valvula = flap ) and stenosis of the pulmonary valve
  • Supravalvular pulmonary stenosis in the main trunk of the pulmonary artery
  • The peripheral pulmonary stenosis as stenosis of the pulmonary artery branches

Pulmonary stenosis without ventricular septal defect accounts for about 10 % of all congenital heart defects, and it is a valvular pulmonary stenosis with more than 90 % of cases. The infundibular pulmonary stenosis occurs less frequently and very rarely are the supravalvular stenosis and peripheral. Also, as part of complex congenital heart disease occurs, the pulmonary stenosis.

Effects

A valvular pulmonary stenosis is caused by a too-tight valve ring and by a malformation of the valve leaflets (only bivalve conditioning, deformation and thickening of the conjoined flap pockets ). In the infundibular stenosis, the narrowing of the outflow tract is short length, pellicular or applied over a long stretch and tubular. Through broad muscle bundles of the right ventricle (heart chamber ) can be virtually divided into two chambers. Depending on the tightness of the stenosis increases the pressure in the ventricle and the muscle wall becomes stronger. Severe pulmonary stenosis may also lead to right heart failure and an extension of the ventricle.

Symptoms

Mild stenosis cause any discomfort. In moderate stenosis, there is shortness of breath and cyanosis of the lips more easily during exercise. Severe stenosis cause already in the idle state, a rapid breathing and cyanosis, the increase in load. Then the physical development is impaired.

Diagnostics

  • Auscultation: systolic Austreibungsgeräusch over the second intercostal space left sternal border, split second heart sound
  • Echocardiography as a non- invasive method
  • Electrocardiogram ( ECG) for the diagnosis of right heart strain
  • Cardiac catheterization for evaluation before surgery and to determine the effect of vasodilating substances ( vasodilators )
  • Determination of brain natriuretic peptide concentration in the blood for the detection of heart failure
  • MRI, CT, scintigraphy to rule out a pulmonary embolism

Therapy

Easier stenoses are not in need of treatment. For medium and higher-grade stenosis today is the dilation with a balloon - heart catheterization available. Rare replacement of heart valve is necessary. As a replacement valves artificial heart valves, human Klappentransplanate or Bioklappen are eligible from animal pericardial tissue. In difficult cases, surgery is performed with a heart - lung machine.

At stenoses, which are caused by vasoconstriction in the lung, including a treatment can be carried out using vasodilators. This disease is called pulmonary hypertension or pulmonary hypertension.

Long-term prospects

The long-term outlook for patients are very good, with the exception of Pulmonary Hypertension. Nevertheless, lifelong check-ups are displayed and endocarditis prophylaxis should be considered for life.

Medical guideline
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