ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT

ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT is a topic covered in the Harrison's Manual of Medicine.

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PULMONIC STENOSIS (PS)

A transpulmonary valve gradient <30 mmHg indicates mild PS, 30–50 mmHg is moderate PS, and >50 mmHg is considered severe PS. Mild to moderate PS rarely causes symptoms, and progression tends not to occur. Pts with higher gradients may manifest dyspnea, fatigue, light-headedness, chest pain (RV ischemia).

Physical Examination

Jugular venous distention with prominent a wave, RV parasternal impulse, wide splitting of S2 with soft P2, ejection click followed by “diamond-shaped” systolic murmur at upper left sternal border, right-sided S4.

ECG

Normal in mild PS; RA and RV enlargement in advanced PS.

CXR

Often shows poststenotic dilatation of the pulmonary artery and RV enlargement.

Echocardiography

RV hypertrophy and systolic “doming” of the pulmonic valve. Doppler accurately measures transvalvular gradient.

Treatment: Pulmonic Stenosis

Symptomatic or severe stenosis requires balloon valvuloplasty or surgical correction.

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PULMONIC STENOSIS (PS)

A transpulmonary valve gradient <30 mmHg indicates mild PS, 30–50 mmHg is moderate PS, and >50 mmHg is considered severe PS. Mild to moderate PS rarely causes symptoms, and progression tends not to occur. Pts with higher gradients may manifest dyspnea, fatigue, light-headedness, chest pain (RV ischemia).

Physical Examination

Jugular venous distention with prominent a wave, RV parasternal impulse, wide splitting of S2 with soft P2, ejection click followed by “diamond-shaped” systolic murmur at upper left sternal border, right-sided S4.

ECG

Normal in mild PS; RA and RV enlargement in advanced PS.

CXR

Often shows poststenotic dilatation of the pulmonary artery and RV enlargement.

Echocardiography

RV hypertrophy and systolic “doming” of the pulmonic valve. Doppler accurately measures transvalvular gradient.

Treatment: Pulmonic Stenosis

Symptomatic or severe stenosis requires balloon valvuloplasty or surgical correction.

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