Pulmonary Stenosis - Types, Causes, Symptoms, Complications, Diagnosis, and Treatment

Introduction:

The narrowing of the pulmonary valve reduces the blood flow to the heart. This condition is called pulmonary valve stenosis. The pulmonary valve is situated between the lower right heart chamber and the pulmonary artery. The lower right heart chamber comprises the right ventricle. The pulmonary valve becomes thick due to stenosis and reduces the blood flow.

What Are the Types of Stenosis?

• Mild Pulmonary Valve Stenosis - Mild cases do not show any symptoms and are treated by medications.

• Moderate And Severe Pulmonary Valve Stenosis - In moderate and severe cases, the valve must be replaced or repaired to ease the blood flow through the pulmonary valve.

What Are the Symptoms?

The symptoms vary depending on the amount of blood flow. The various symptoms are as follows;

• In moderate and severe cases, pulmonary valve stenosis shows symptoms during physical exertion.

• A murmur (unusual sound) from the heart is heard during the auscultation in the stethoscope.

• The person affected by pulmonary valve stenosis becomes exhausted and restless even after climbing a few stairs.

• Physical activities like exercise, running, and workouts result in breathing difficulty.

• The patient feels uncomfortable and has pain along the chest area.

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• The patient faints (loss of consciousness) often due to reduced blood flow.

• In children, congenital heart disease results in cyanosis of the blood. The child appears blue in severe cases.

When Should You Visit a Doctor?

Visit the doctor if there are any symptoms like discomfort in the chest, shortness of breath, and loss of consciousness. Early diagnosis and treatment of pulmonary stenosis in the child can save the child from further complications.

What Are the Causes?

In congenital heart disease, the development of the pulmonary valve is not complete. It occurs during pregnancy and is termed a birth defect. The pulmonary valve comprises three cusps (a flap-like tissue). These cusps open and close, corresponding to each heartbeat. During the opening and closing of the valve, the blood flows in the right direction. The thickness of the pulmonary valve increases and becomes stiff due to pulmonary valve stenosis.

In severe cases of stenosis, one or more cusps fuses and block the blood flow. The blood flows through the narrowest valve. It results in improper blood flow to the right ventricle (lower right heart chamber). This eventually increases the pressure in the right ventricle. This pressure is created as the heart tries to pump the blood through the small opening in the valve. It causes a strain in the muscular wall of the right ventricle. The thickness of the muscular wall increases due to the pressure.

What Are the Risk Factors?

Various conditions increase the risk of pulmonary valve stenosis. They are as follows;

• Rheumatic Fever:

The inflammation of the heart tissue due to Streptococcus bacteria causes rheumatic fever. It starts as a throat infection and can evolve into chronic heart disease. There is a thickening of the heart muscle due to inflammation. It influences the heart valves and causes valve stenosis or valve regurgitation. The valve stenosis reduces the blood flow in the valves. The ability of the heart to pump blood is affected due to the narrowing of the valve.

• Carcinoid Heart Disease:

It is also called carcinoid cancer and is a very rare disease. The level of serotonin (hormone) in the blood increases enormously, resulting in valvular fibrosis. Deposition of plaque causes tricuspid valve lesions and pulmonary stenosis. The carcinoid tumor develops due to this fibrous deposition in the heart valves and impacts cardiac failure.

• Noonan Syndrome:

Noonan syndrome is a genetic disorder that occurs in children. This syndrome has characteristics like facial deformity, defect in the heart, and developmental deformity. The function of the heart is abnormal due to malformation.

• Rubella:

Rubella is also known as German measles. It is highly contagious during pregnancy. Due to the infection, heart problems occur in the child. The child is at high risk for pulmonary valve stenosis.

What Are the Medical Complications?

• Infective Endocarditis:

As the name says, it is due to an infection in the heart. Patients with valvular disorders are more prone to infections. Pulmonary valve stenosis causes bacterial infection in the lining of the heart.

• Arrhythmia:

Arrhythmia means an unusual heartbeat. Severe pulmonary stenosis is life-threatening. It results in an irregular heartbeat.

• Ventricular Hypertrophy:

Pulmonary stenosis causes narrowing of the blood vessels. The right ventricle pumps the blood into the pulmonary artery with excess pressure. This creates strain in the right ventricle and results in the thickening of the heart muscle.

• Cardiac Failure:

There are various conditions associated with cardiac failure. The functional efficiency of the heart is less in the case of pulmonary valve stenosis. The blood flow to the heart is slow due to valvular dysfunction. Also, ventricular hypertrophy provokes cardiac failure.

• Complication During Labor:

Pregnant women affected by pulmonary valve stenosis are at high risk during labor. There may be shortness of breath due to pulmonary valve stenosis. However, appropriate treatment by the medical professional can save both the mother and baby.

What Are the Diagnostic Procedures for Pulmonary Valve Stenosis?

A skilled physician can identify the condition with auscultation (stethoscope). A heart murmur is the most common symptom of pulmonary valve stenosis. The unusual rasping sound of the heartbeat is heard during auscultation. If there is a murmur, then other tests should be made to diagnose the condition.

• X-Rays - X-rays are used to identify the abnormalities in the heart, blood vessels, ribs, and bones. Chest X-rays are used to observe the shape of the heart and lungs.

• MRI - Magnetic resonance imaging (MRI) produces images in black and white. It is used to investigate soft tissue and bones. The doctors use magnetic resonance imaging to check the blocks in blood vessels and to observe heart problems.

• Electrocardiogram (EKG) - The electrical activity of the heart is altered in heart problems. The pumping activity of the heart, abnormalities in the heart chambers, and irregular heartbeats can be identified using EKG.

• Echocardiogram (ECG) - The image of the heart is obtained with the help of sound waves. The change in the size of the heart chambers can be visualized using an echocardiogram. The malfunction of the heart valves due to blood clot are interpreted using an echocardiogram.

How Is Pulmonary Valve Stenosis Treated?

Medications are prescribed by medical professionals for adequate blood flow to the heart.

• Prostaglandins are used to improve the blood flow to the heart.

• Anticoagulants are used as blood-thinning agents to prevent blocking in the blood vessel.

Surgery is required for severe pulmonary valve stenosis. Valvuloplasty is a procedure that involves stretching the valves to improve blood flow. A catheter is used to treat heart problems like blocks in the blood vessels, valvular defects, and irregular heartbeat. It is also used to measure the pressure in heart chambers and treat the same. The catheter has a balloon attached to one end. When the catheter is inserted, the balloon enlarges and stretches the heart valves. It is used to repair the heart valves and congenital heart defects.

Conclusion

There is a high recovery rate for mild pulmonary valve stenosis. Mild stenosis is recovered with medications. However, severe stenosis requires valvular replacement. To avoid such complications, follow a healthy diet and lead a life free from smoking and alcohol. A healthy diet like cereals, vegetables, and fruits can enhance a healthy lifestyle. Visit the cardiologist regularly to overrule the heart problems.