test 5 pulmonary stenosis

Question 1

Names of Pulmonary Stenosis based on where the stenosis is present

Answer 1

A. Supravalvular
B. Valvular Stenosis
C. Subvalvular / Infundibular Stenosis

Question 2

Pulmonary Stenosis (PS)

Answer 2

 10% of Congenital Heart Diseases
 Pulmonary Valve and/or RV outflow tract is restricted
 Range from Mild to Severe
 PS causes obstruction to the ejection of blood from the RV (forces RV tension development)
 Increased work load of the ventricle
 Severe and/or Prolonged = Right Ventricular Hypertrophy

Question 3

Supravalvular Pulmonary Stenosis

Answer 3

 Pulmonary artery lumen above the pulmonary valve opening is narrowed
 Can be main or branch PA

Question 4

Valvular Pulmonary Stenosis

Answer 4

 Leaflets of PV thickened/ fused at edges
 Valve doesn’t open fully
 May see post-stenotic dilation of the main PA
 Valve may be bicuspid

Question 5

Subvalvular Pulmonary Stenosis (Infundibular)

Answer 5

 RVOT stenosis, below Pulmonary Valve

 Obstructed by muscular tissue

Question 6

Pulmonary StenosisMay be classified by

Answer 6

 RV Pressure
 Mild: 45mmHg or less
 Moderate: 46-89mmHg
 Severe: 90mmHg (suprasystemic)
 Will develop right heart failure
 PS in infancy is always severe.
 If there is an ASD – Right to left shunting will occur
 Cyanosis
 Moderate pulmonary stenosis (or higher), will see right ventricular hypertrophy

Question 7

Repair of Pulmonary Stenosis that is purely valvular

Answer 7

 Balloon valvuloplasty

 Commissurotomy - incise the fused commissures via direct vision

Question 8

Repair of Infundibular (subvalvular) Pulmonary Stenosis

Answer 8

 Hypertrophied muscle in the outflow tract is resected

Question 9

Repair of Supravalvular Pulmonary Stenosis

Answer 9

 Depends where stenotic lesion is
 Remove stenosis/ balloon angioplasty or stent
 Patch repair/ enlargement