Pulmonary Valve Stenosis - Symptoms, Diagnosis, Risks
Before discussing pulmonary stenosis, it is usually helpful for patients to learn about the anatomy of the pulmonary valve. That said... The pulmonary valve, one of four inside the heart, is comprised of three cusps, also called heart valve flaps or leaflets. As the heart beats, the pulmonary valve opens to allow blood to flow into the pulmonary artery, which will conduct the blood to the lungs. The valve then closes tightly so that the blood cannot flow back into the heart's right ventricle. If the cusps cannot separate, are defective, or surrounding tissue obstructs their opening, blood flow is restricted.
While the cause of congenital pulmonary valve stenosis remains a mystery and it is also unknown why older patients may develop the condition (degenerative), there are two conditions that may contribute to the risk.
- Rheumatic fever is a complication developing from a streptococcus bacterial infection, such as scarlet fever or strep throat. Rheumatic fever can damage the valves in the heart.
- Another condition, called Carcinoid syndrome, can also lead to heart valve problems, This syndrome is the result of serotonin being released from Carcinoid tumors, or growths, that develop in the patient's digestive system.
Although pulmonary valve stenosis can develop due to complications of another disease or condition, it is normally congenital, like a bicuspid aortic valve defect. This means that the child is born with the condition, which develops while the infant is still in the womb. While it is not known why the valve does not develop properly, the condition is often observed in infants with other congenital heart conditions.
Pulmonary Stenosis Symptoms
Some patients may experience only mild symptoms, or there may be no identifiable symptoms whatsoever, commonly referred to as asymptomatic. Some symptoms may be noticed only during physical exertion.
Patients with pulmonary stenosis may have:
- Chest pain
- Feel short of breath
The condition may also be found by a physician who notices a heart murmur while examining the patient with a stethoscope. Mild cases do not typically grow worse with time, but if the condition is moderate to severe, the stenosis may worsen and need surgical correction.
Risks Associated With Pulmonary Stenosis
Individuals with pulmonary stenosis are at greater risk of developing infectious endocarditis, a bacterial infection of the heart's interior lining. The condition is also associated with an increased risk of arrhythmia, atrial fibrillation, or an irregular heartbeat. Arrhythmia is normally not dangerous unless the valve is severely stenotic.
In severe cases, the right ventricle must work harder to pump blood into the body's pulmonary artery. This can cause the ventricle walls to thicken and the chamber to enlarge. The heart can become weakened and stiff, which may lead to heart failure. Symptoms of heart failure include fatigue, shortness of breath, and swelling in the abdomen and legs.
Diagnosing Pulmonary Stenosis
To diagnose pulmonary valve stenosis, the physician may rely on one or more tests.
- The electrocardiogram is often one of the first tests ordered, and can help determine whether the right ventricle wall has thickened. Echocardiograms are a type of sonogram that uses sound to produce images of the patient's heart.
- Echocardiograms are often used to check the right ventricle's functionality and to define where the stenosis lies and how severe it is.
- A procedure known as cardiac catheterization may also be used. This procedure involves threading a small tube into a vein or artery in the patient's groin until it reaches the heart. A dye, injected into the tube, makes areas of the heart visible for X-rays that would not have been shown otherwise.
Treating Mild, Moderate & Severe Pulmonary Stenosis
Mild cases of pulmonary stenosis normally do not need treatment, although the physician will want to monitor the patient regularly. More severe cases may be treated with balloon valvuloplast, heart valve repair surgery or heart valve replacement surgery - either a mechanical valve or a biological valve (shown below).
While each patient case is specific, the surgical approach to treating pulmonary stenosis will be determined by the severity of stenotic valve and the current or probable damage to your heart over time.
Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.