Narayana Health Care

What Is Pulmonary Valve Stenosis?

Pulmonary stenosis is the thickening, narrowing, and stiffening of the pulmonary valve.

To understand pulmonary valve stenosis, first, we need to understand the function of pulmonary valves. The pulmonary valve lies between the right lower chamber of the heart (right ventricle) and the pulmonary artery (artery carrying blood to lungs). They open to let blood move ahead to the lungs and then quickly close to prevent blood from flowing backwards.

In pulmonary stenosis, the pulmonary valve becomes too narrow, too small, and can’t open fully. It puts additional pressure on the right ventricle to pump blood out to the lungs. This excess pressure may cause thickening of the right ventricle, making it difficult for the heart to pump blood.

What are the most common signs and symptoms of pulmonary valve stenosis?

Symptoms of pulmonary valve stenosis depend on the extent of narrowing and stiffening of the pulmonary valve. Many people with stenosis may not have any symptoms. Some may have mild symptoms not causing any discomfort. The most common sign of pulmonary stenosis is a distinct heart sound (murmur) which a cardiologist may notice during chest examination by stethoscope.

Some of the most common symptoms of severe pulmonary valve stenosis are:

• Cyanosis (a bluish tint to the skin) in newborns. Cyanosis results from decreased oxygen levels in the blood
• Fatigue and malaise
• Poor weight gain
• Difficulty and shortness of breath
• Heart palpitations (sensation of irregular heartbeat)
• Pain in chest
• Fainting
• Loss of appetite or poor eating

What are the most common causes of Pulmonary Stenosis?

In most patients, pulmonary valve stenosis is a congenital defect, meaning a baby is born with it.

In these cases, pulmonary stenosis happens due to impaired development of the baby’s heart during pregnancy. Doctors may not know the exact cause of this problem in heart development.

Pulmonary stenosis may also occur in adults as a complication of various diseases that affect the heart. Conditions like rheumatic fever and carcinoid tumors in the digestive system can have pulmonary stenosis as one of the complications.

What are the potential complications of untreated pulmonary valve stenosis?

Untreated severe cases of pulmonary valve stenosis may lead to several complications.

Some of them are:

• Right ventricular hypertrophy (enlargement): It weakens and may cause permanent damage to the heart.
• Irregular heartbeat or arrhythmia
• Cyanosis: A decrease in the supply of oxygen-rich blood to your tissues, may cause bluish discolouration of the skin
• Heart infection or endocarditis
• Untreated pulmonary valve stenosis makes your heart work harder to pump blood to the lungs that can lead to heart failure and death.

How can doctors diagnose pulmonary valve stenosis?

A doctor can diagnose pulmonary stenosis before or after birth.

Before birth, a doctor can identify pulmonary stenosis using a fetal echocardiogram (echo). A fetal echo creates a moving picture of the unborn baby’s heart using sound waves. This helps a doctor to ascertain the anatomy and physiology of a baby’s heart while still in the mother’s womb.

After birth, the first sign of pulmonary stenosis is a heart murmur. Upon examination with a stethoscope, a doctor may listen to an extra click, rasping, blowing, or whooshing sound.

To further confirm the diagnosis, the doctor may recommend several tests to see if there is narrowing or stiffening of the pulmonary valve or whether the blood is flowing out freely. These tests are

• Chest Xray
• Echocardiogram
• MRI Scan

Is pulmonary stenosis always requiring treatment?

The treatment of pulmonary stenosis depends on some factors, which include but are not limited to

• Location of the defect
• Size of the defect
• Age of the patient
• Structural and functional integrity of other heart valves
• Previous history of heart surgery
• Presence of other medical conditions

If the stenosis is asymptomatic or has very mild symptoms, it may not require any treatment.

In some cases, a cardiologist may prescribe some medicines for symptomatic relief. Some of these medicines are:

• Prostaglandins: to improve blood flow
• Blood thinners: to reduce clotting
• Anti-arrhythmia pills: to prevent irregular heart rhythms

For patients with severe pulmonary stenosis, a doctor may recommend surgery to fix or replace the valve.

The procedures for treating pulmonary stenosis are:

• Balloon valvuloplasty: A doctor inserts a catheter into the heart and threads a balloon through the pulmonary valve. This balloon inflates and stretches the heart’s wall.
• Valve replacement with a mechanical or a biological valve.

Dr. Dhananjay R S | Consultant – Cardiology – Adult, Cardiology – Paediatric | SS Narayana Heart Centre, Davangere