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

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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.


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


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


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


Symptomatic or severe stenosis requires balloon valvuloplasty or surgical correction.

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Loscalzo, Joseph, et al., editors. "ACYANOTIC CONGENITAL HEART LESIONS WITHOUT a SHUNT." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. 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: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623306/all/ACYANOTIC_CONGENITAL_HEART_LESIONS_WITHOUT_A_SHUNT. Accessed April 21, 2019.
ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from 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: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 April 21]. 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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TY - ELEC T1 - ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT ID - 623306 ED - Loscalzo,Joseph, ED - Jameson,J Larry, ED - Longo,Dan L, ED - Hauser,Stephen L, ED - Fauci,Anthony S, ED - Kasper,Dennis L, BT - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623306/all/ACYANOTIC_CONGENITAL_HEART_LESIONS_WITHOUT_A_SHUNT PB - McGraw Hill Inc. ET - 19 DB - Harrison's Manual of Medicine DP - Unbound Medicine ER -