ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT
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
Treatment: Pulmonic Stenosis
Symptomatic or severe stenosis requires balloon valvuloplasty or surgical correction.
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Citation
Kasper, Dennis L., et al., editors. "ACYANOTIC CONGENITAL HEART LESIONS WITHOUT a SHUNT." Harrison's Manual of Medicine, 20th ed., McGraw Hill Inc., 2020. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623306/all/ACYANOTIC_CONGENITAL_HEART_LESIONS_WITHOUT_A_SHUNT.
ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT. In: Kasper DLD, Fauci ASA, Hauser SLS, et al, eds. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623306/all/ACYANOTIC_CONGENITAL_HEART_LESIONS_WITHOUT_A_SHUNT. Accessed December 2, 2024.
ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT. (2020). In Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (Eds.), Harrison's Manual of Medicine (20th ed.). McGraw Hill Inc.. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623306/all/ACYANOTIC_CONGENITAL_HEART_LESIONS_WITHOUT_A_SHUNT
ACYANOTIC CONGENITAL HEART LESIONS WITHOUT a SHUNT [Internet]. In: Kasper DLD, Fauci ASA, Hauser SLS, Longo DLD, Jameson JLJ, Loscalzo JJ, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. [cited 2024 December 02]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623306/all/ACYANOTIC_CONGENITAL_HEART_LESIONS_WITHOUT_A_SHUNT.
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