Pulmonic Stenosis Follow-up

  • Author: Xiushui (Mike) Ren; Chief Editor: Richard A Lange, MD   more...
 
Updated: Jan 4, 2012
 

Deterrence/Prevention

Infective endocarditis prophylaxis: The American Heart Association (AHA) Guidelines on Prevention of Bacterial Endocarditis considers all forms of isolated pulmonic stenosis (PS) to be in the moderate-risk category, and any PS associated with complex congenital heart disease to be in the high-risk category. Therefore, antibiotic prophylaxis is recommended for all forms of PS.

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Prognosis

  • Except for critically severe stenosis in neonates, survival is the rule for individuals with congenital PS.[3]
  • The long-term course of individuals with mild PS is indistinguishable from that of the unaffected population. Mild PS does not tend to progress in severity; rather, pulmonic valve orifice size usually increases with body growth.
  • Severe PS may result in outflow obstruction that progresses over a period of years despite body growth (60% of patients require intervention within 10 y of diagnosis).
  • With appropriate intervention, those with moderately severe PS have an excellent prognosis.
  • The functional effect of PS may change during an individual's lifetime such that symptoms or limitations occurring in childhood may resolve by adulthood.
  • Available data support relieving moderately severe and severe PS in childhood, with follow-up care through adolescence and into adulthood. When PS is corrected during childhood, the life expectancy of the affected individual matches that of the unaffected age- and sex-matched cohort.
  • The more severe and protracted the course of PS, the less optimal the outcome of intervention, including death due to RV failure in the most severe cases.
  • Balloon valvuloplasty is preferred, provided the valve is compliant and mobile. Those with severe valvular fibrocalcific thickening are more likely to require a surgical approach. The recurrence rate of PS in patients who are treated surgically is approximately 4%. Long-term results of balloon valvuloplasty are comparable to the results of surgical repair, with the rate of recurrence of severe PS less than 5%. A recent study shows that long-term follow-up of patients after surgical treatment for isolated pulmonary valve stenosis resulted in a high rate of reinterventions (53% at a median follow-up of 34 years). Thus, close follow-up in postsurgical patients is needed.
  • Adult patients are more likely to present with subvalvular hypertrophic pulmonic stenosis or valvular fibrocalcific thickening. Secondary subvalvular hypertrophic stenosis regresses following correction of the primary valvular abnormality, and residual dilatation of the pulmonary trunk is not significant clinically, even when marked. Recognizing subvalvular hypertrophy is important, since it may lead to dynamic outflow obstruction during the acute phase following correction of valvular stenosis. With few exceptions, postvalvuloplasty pulmonic regurgitation is of mild-to-moderate severity.
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Contributor Information and Disclosures
Author

Xiushui (Mike) Ren  MD, Cardiovascular Physician, Department of Cardiology, Kaiser Medical Center; Associate Director of Research, Cardiovascular Diseases Fellowship, California Pacific Medical Center

Xiushui (Mike) Ren is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, and American Society of Echocardiography

Disclosure: Nothing to disclose.

Coauthor(s)

Lauralyn B Cannistra, MD, FACC  Director of Echocardiography Lab and Cardiac Rehabilitation, Assistant Professor, Department of Medicine, Memorial Hospital of Rhode Island, Brown University School of Medicine

Lauralyn B Cannistra, MD, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Anesthesiologists, American Society of Echocardiography, and Rhode Island Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Park W Willis IV, MD  Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine

Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marschall S Runge, MD, PhD  Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association

Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD  Professor and Executive Vice Chairman, Department of Medicine, Director, Office of Educational Programs, University of Texas Health Science Center at San Antonio

Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors

Disclosure: Nothing to disclose.

References

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Pulmonic stenosis. Echocardiogram of a patient with severe pulmonic stenosis. This image shows a parasternal short axis view of the thickened pulmonary valve.
Pulmonic stenosis. Echocardiogram of a patient with severe pulmonic stenosis. This image shows a Doppler scan of the peak velocity (5.2 m/s) and gradients (peak 109 mm Hg, mean 65 mm Hg) across the valve.
Pulmonic stenosis. Echocardiogram of a patient with severe pulmonic stenosis. This image shows that moderately severe pulmonary insufficiency (orange color flow) is also present.
This video is an echocardiogram of a patient with severe pulmonic stenosis. The first segment shows the parasternal short axis view of the thickened pulmonary valve. The second segment shows the presence of moderate pulmonary insufficiency (orange color flow).AV=Aortic valve, PV=Pulmonary valve, PA=Pulmonary artery, PI=Pulmonary insufficiency
 
 
 
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