RT Book, Section
A1 Kiefer, Todd
A1 Granger, Christopher B.
A1 Jackson, Kevin P.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1193146833
T1 Pulmonary Valve Stenosis
T2 Current Medical Diagnosis & Treatment 2023
YR 2023
FD 2023
PB McGraw-Hill Education
PP New York, NY
SN 9781264687343
LK accessmedicine.mhmedical.com/content.aspx?aid=1193146833
RD 2024/09/19
AB ESSENTIALS  OF  DIAGNOSISAsymptomatic  unless  lesion  is  at  least  moderately  severe.Severe  cases  may  present  with  right-sided  heart  failure.High-pitched  systolic  ejection  murmur  maximal  in  the  second  left  interspace  with  radiation  to  the  left  shoulder.P2  delayed  and  soft  or  absent.Pulmonary  ejection  click  often  present  and  decreases  with  inspiration—the  only  right  heart  sound  that  decreases  with  inspiration;  all  other  right  heart  sounds  increase.Echocardiography/Doppler  is  diagnostic.Patients  with  peak  pulmonic  valve  gradient  greater  than  64  mm  Hg  or  a  mean  of  35  mm  Hg  by  echocardiography/Doppler  should  undergo  intervention  regardless  of  symptoms.  Otherwise,  operate  for  symptoms  or  evidence  for  right  ventricular  (RV)  dysfunction.A  dysplastic  pulmonary  valve  usually  requires  surgical  treatment,  while  a  domed  pulmonary  valve  stenosis  usually  can  be  treated  with  balloon  valvuloplasty.RV  outflow  tract  obstruction  due  to  conduit  stenosis,  homograft  stenosis  and  some  prior  bioprosthetic  valve  dysfunction  may  be  treated  with  a  percutaneous  pulmonary  valve  replacement.