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Saturday, February 19, 2011

PULMONARY STENOSIS

Virtually always congenital. It may be isolated or associated with other abnormalities such as fallot's tetralogy.

Clinical features
Mild or moderate pulmonary stenosis is asymptomatic severe pulmonary  stenosis cause right heart failure.
The principal finding on examination is an ejection systolic murmur loudest to the left of the upper sternum, radiating towards the left shoulder. There may be a thrill, best felt when the patient leans forward and breathes out. The murmur is often preceded by an ejection sound. Delay in right ventricular ejection may cause wide splitting of the second heart sound.
Severe pulmonary stenosis is characterised clinically by a loud harsh murmur, an increased right ventricular thrust, prominent a waves in the jugular pulse, ECG evidence of right ventricular hypertrophy, and post stenotic dilatation on the chest radiograph. The severity of stenosis can be further assessed by Doppler ultrasound or cardiac catheterisation.
Management
Mild to moderate isolated pulmonary stenosis is common, does not usually progress, and does not require treatment. It is a low-risk lesion for infective endocarditis. Severe pulmonary stenosis is treated by percutaneous pulmonary balloon valvuloplasty or, if the valve is very rigid, by surgical ballon valvotomy. Long-term results are very good. Postoperative pulmonary regurgitation is common but harmless.

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