Harrison's Manual of Medicine
ACYANOTIC CONGENITAL HEART LESIONS WITHOUT A SHUNT
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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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