Pulmonic Stenosis Treatment & Management

Updated: Dec 22, 2014
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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Treatment

Surgical Care

Traditionally, pulmonic stenosis (PS) was treated by surgical valvotomy. Since its introduction in 1982, however, percutaneous balloon valvuloplasty has become the initial intervention in children, adolescents, and adults with congenital valvar PS. Balloon valvuloplasty should be considered in any patient with a transvalvular pressure gradient greater than 50 mm Hg.

Occasionally, balloon valvuloplasty is not successful. These patients tend to have valvular dysplasia (eg, Noonan syndrome) or a hypoplastic pulmonic valve annulus and, therefore, may require surgical valvotomy.

Pulmonary artery balloon angioplasty with or without placement of an expandable metal stent can be used to treat supravalvular PS and PPS. Expandable metal stents can overcome an obstruction successfully; however, the need for stent reexpansion as the individual grows remains problematic.

The American Heart Association/American College of Cardiology [3] and the European Society of Cardiology [4] have published guidelines on the management of patients with valvular heart disease.

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Activity

Pregnancy

Avoidance of vigorous exercise in pregnancy is recommended, especially during the second half of pregnancy in patients with moderate or severe gradients.

One study found that pregnant patients with PS had favorable outcomes and low maternal and fetal complications. This is in contrast to left heart obstructive lesions such as aortic and mitral stenosis. [5]

Athletes

Athletes with mild PS and gradients less than 50 mm Hg have no activity limitations. Those with more severe PS can participate in low-intensity competitive sports.

For more details, see Diagnostic Considerations.

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