Those with more-severe pulmonary stenosis may first notice symptoms while exercising. Babies with pulmonary valve stenosis and other congenital heart defects may appear blue cyanotic. If you or your child has pulmonary stenosis or another heart problem, prompt diagnosis and treatment can help reduce the risk of complications. Pulmonary valve stenosis is most often a congenital heart defect. The exact cause is unclear. The pulmonary valve doesn't develop properly as the baby is growing in the womb.
The pulmonary valve is made of three thin pieces of tissue called flaps cusps. The cusps open and close with each heartbeat and make sure blood moves in the right direction.
In pulmonary valve stenosis, one or more of the cusps may be stiff or thick, or the cusps may be joined fused together. As a result, the valve doesn't open fully. The smaller valve opening makes it harder for blood to flow out of the lower right heart chamber right ventricle. Pressure increases inside the right ventricle as it tries to push blood through the smaller opening.
The increased pressure creates a strain on the heart that eventually causes the right ventricle's muscular wall to thicken. The valve is opened by the increased blood pressure of the ventricular systole contraction of the muscular tissue , pushing blood out of the heart and into the artery.
It closes when the pressure drops inside the heart. It is located in the right ventricle of the heart. The pulmonic valve opens into the pulmonary artery. The frequency of this cycle depends upon the heart rate. Pulmonary stenosis is a condition where the blood flow out of the heart is obstructed at the pulmonic valve.
The most common cause of this is congenital heart disease, although rheumatic heart disease and a malignant carcinoid tumor can also initiate the problem. The condition is treated by surgical repair or replacement of the pulmonic valve. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings for the tricuspid and mitral valves and exits for the pulmonary and aortic valves.
Pulmonary valve repair and pulmonary valve replacement are procedures that treat diseases affecting the pulmonary valve. The pulmonary valve is one of four valves that regulate blood flow in the heart. The valve lies between the lower right heart chamber right ventricle and the pulmonary artery. Pulmonary valve disease is a condition in which the pulmonary valve doesn't work properly.
The condition can interrupt blood flow from your heart to your lungs. It may occur on its own or as part of other congenital heart defects, such as tetralogy of Fallot.
Often, the condition may only be detected by a physical evaluation or heart imaging for another reason. Pulmonary valve repair or pulmonary valve replacement can treat pulmonary valve disease and help restore normal blood flow, reduce symptoms, prolong life and help preserve the function of your heart muscle. In pulmonary valve regurgitation, a leaky valve allows blood to flow backward into the heart rather than directly to the lungs for oxygen.
Pulmonary valve disease treatment depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse. For some people with mild pulmonary valve disease without symptoms, careful monitoring under a doctor's supervision may be all that's needed. But in many cases, pulmonary valve disease and dysfunction progress in adulthood and get worse without medical treatment.
Types of pulmonary valve disease that may require treatment with pulmonary valve repair or pulmonary valve replacement include:. In general and whenever possible, pulmonary valve repair is the preferred option because it's associated with a lower risk of infection, preserves valve strength and function, and eliminates the need to take blood-thinning medications, which may be necessary with pulmonary valve replacement.
Pulmonary valve repair and pulmonary valve replacement surgery risks vary depending on your health, the type of procedure, and the expertise of the surgeon and health care team. To minimize potential risk, pulmonary valve surgery should generally be performed at a medical center with staff experienced in these procedures and that performs high volumes of pulmonary valve surgeries. Your Mayo Clinic treatment team will discuss any questions you might have about your pulmonary valve repair or pulmonary valve replacement procedure at Mayo Clinic.
Before surgery to have your pulmonary valve repaired or replaced, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery. Before being admitted to the hospital for your surgery, talk to your caregivers about your hospital stay and discuss any help you may need when you return home.
For most pulmonary valve repair and replacement procedures, you'll receive medications anesthetics that put you in a sleep-like state so you won't feel any pain during the surgery. You'll also be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.
Pulmonary valve repair is usually performed via open-heart surgery and opening of the chest bone sternotomy. Doctors wire the bone back together after the procedure to prevent movement and aid in healing. Pulmonary valves that can't open fully due to pulmonary valve stenosis may be repaired with surgery or a less invasive procedure called balloon valvuloplasty, which uses an approach called cardiac catheterization.
You're usually awake during cardiac catheterization, and it requires a much shorter hospital stay than traditional heart surgery. During balloon valvuloplasty, your doctor inserts a thin, hollow tube catheter in a blood vessel, usually in your groin, and threads it to your heart.
The catheter has a balloon at its tip that can be inflated to help widen the narrowed pulmonary valve and then deflated for removal. Balloon valvuloplasty is often used to treat infants and children with pulmonary valve stenosis. However, the valve tends to narrow again in adults who have had the procedure. You may need additional procedures to treat the narrowed valve over time.
In a biological pulmonary valve replacement, a tissue biological valve replaces the damaged valve. Some apply this term to all cases with an S wave in each standard lead, regardless of magnitude, while others use it to indicate situations where the prominent QRS deflection is an S wave in these leads.
The S3 sound is actually produced by the large amount of blood striking a very compliant left ventricle. The third heart sound S3 occurs in the rapid filling period of early diastole. The fourth heart sound S4 occurs in late diastolic periods right before the first heart sound.
The presence of S4 is due to the forceful contraction of the atria in an effort to overcome an abnormally stiff or hypertrophic ventricle [8]. The first heart sound S1 represents closure of the atrioventricular mitral and tricuspid valves as the ventricular pressures exceed atrial pressures at the beginning of systole point a. The second heart sound S2 represents closure of the semilunar aortic and pulmonary valves point d.
The second heart sound S2 occurs when the aortic and pulmonic valves, also known as the semilunar valves, close. S1 occurs just after the beginning of systole and is predominantly due to mitral closure but may also include tricuspid closure components. The loudness of each component of the second heart sound is proportional to the respective pressures in the aorta and pulmonary artery at the onset of diastole. Dilatation of the aorta or pulmonary artery may also cause accentuation of the aortic and pulmonic components, respectively.
S1 — The first heart sound lub can be heard the loudest at the mitral area. This sound represents the closure of the mitral and tricuspid valves and is a low pitched, dull sound at the beginning of ventricular systole.
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