Valvar Pulmonary Stenosis Follow-up

Updated: Jun 26, 2014
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Follow-up

Further Outpatient Care

Clinical, ECG, and Doppler echocardiographic evaluation are recommended at 1 month, 6 months, and 12 months after balloon pulmonary valvuloplasty and yearly thereafter.

Patients with trivial and mild pulmonary stenosis do not need intervention to relieve the pulmonary valve obstruction. However, they should be clinically followed up at periodic intervals (eg, on a yearly basis).

Routine well-child care, including immunizations, as per the primary physician, is suggested.

Physical activity should be normal.

Most patients with pulmonary stenosis are given prophylaxis for subacute bacterial endocarditis (SBE).

Opinions differ about the need for SBE prophylaxis in patients with valvar pulmonary stenosis because of the extremely low incidence of pulmonary valve endocarditis in this relatively large subpopulation. The author recommends SBE prophylaxis for all patients with valvar pulmonary stenosis.

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Further Inpatient Care

The neonate with critical pulmonary valve stenosis requires special consideration. Patients with critical pulmonary stenosis may present with near–pulmonary atresia (cyanotic lesion) with a small and often inadequate right ventricle. These patients survive because of a patent ductus arteriosus (PDA). Although balloon pulmonary valvuloplasty produces good results, nearly 25% patients require reintervention to address related complications, restenosis, and associated defects.

Patients with associated severe infundibular or supravalvar pulmonary stenosis require surgical intervention.

Definitive repair may not be possible if the right ventricle is hypoplastic or if single ventricular palliation (eg, the Fontan procedure or a variation of this) is needed. The modified Fontan procedure currently used is staged cavopulmonary connection.

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Patient Education

Reassure patients and parents of children with mild valvar pulmonary stenosis that this condition is not related to or associated with coronary artery disease, dysrhythmia, or sudden death.

Insurability may become a factor in obtaining further care. Patients are no more at risk for disastrous health consequences than is the usual population.

Provided the patient is asymptomatic and acyanotic and provided that initial Doppler echocardiograms show only mild valvar pulmonary stenosis, yearly screening examination and ECG are prudent follow-up care.

If evaluations performed a few years after the initial evaluation reveal no clinically significant change, the patient may be followed up once every 3-5 years.

For patient education resources, see the Heart Health Center, as well as Tetralogy of Fallot.

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