Pulmonic Valvular Stenosis Treatment & Management

  • Author: Allysia M Guy, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Aug 16, 2010
 

Prehospital Care

  • If the patient has a large left-to-right shunt, such as patent ductus arteriosus or ventricular septal defect, and is in respiratory distress, diuresis is effective in reducing the cyanosis secondary to pulmonary edema.
  • Use of oxygen may reduce pulmonary artery pressure in patients with a reactive pulmonary vasculature, thus increasing pulmonary blood flow.
  • Oxygen should be administered to any cyanotic patient in respiratory distress.
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Emergency Department Care

Management depends on the degree of stenosis. Therefore, clinical evaluation as well as imaging is will direct management. Cardiology or cardiothoracic consultation is needed if imaging studies indicate right outflow tract obstruction.

  • Severe stenosis, a peak gradient of 60 mm Hg or more, requires emergent dilatation of valves by balloon valvulotomy.[11]
  • Patients with mild pulmonic valvular stenosis usually do not require any treatment.
  • Patients with severe or symptomatic infundibular or supravalvular pulmonary stenosis require prompt intervention. Valvulotomy is standard of care in these patients.
  • Frequently, cyanotic infants with respiratory distress and hypotension/shock undergo a workup as that for septic patients.
  • Bacterial endocarditis prophylaxis
    • During the Second Natural History Study of Congenital Heart Defects, 592 patients with pulmonic valvular stenosis were followed for 10,688 person-years; only one patient had an episode of bacterial endocarditis.[29]
    • Pulmonic valvular stenosis is not specifically mentioned in the 2007 American Heart Association (AHA) guidelines for antibiotic prophylaxis to prevent bacterial endocarditis. This guideline recommends prophylaxis for endocarditis in the 6 months following repair of a congenital heart defect. Additionally, prophylaxis is required for lifetime for individuals who have prosthetic valves.[30]
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Consultations

  • Pediatric cardiologist
  • Intensivist
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Contributor Information and Disclosures
Author

Allysia M Guy, MD  Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mert Erogul, MD  Assistant Professor of Emergency Medicine, University Hospital of Brooklyn: Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Mert Erogul, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Kurt Pflieger, MD, FAAP  Active Staff, Department of Pediatrics, Lake Pointe Medical Center

Kurt Pflieger, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter MC DeBlieux, MD  Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine

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

David Eitel, MD, MBA  Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, David J Wallace, MD, MPH, to the development and writing of this article.

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