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Isolated pulmonary stenosis: symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Isolated stenosis of the pulmonary artery among all congenital heart defects is from 6 to 8%. More often the constriction is located in the area of the valves of the pulmonary artery and is represented by a diaphragm with a central or eccentric orifice with a diameter of 1 to 10 mm.
Because of constriction, a pressure gradient is formed between the right ventricle and the pulmonary artery. Pressure in the right ventricle rises, there is a deficiency of the tricuspid valve, right ventricular failure develops with an increase in the liver, an increase in edema. If an oval window is open, it is possible to discharge blood under high pressure. In this case, diffuse cyanosis occurs.
On examination, the heart region is not visually visually altered, the boundaries of relative cardiac dullness are slightly enlarged. Systolic murmur in the second and third intercostal space on the left is heard.
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How to recognize an isolated stenosis of the pulmonary artery?
The ECG shows a deviation of the electric axis of the heart to the right, signs of right ventricular overload, often incomplete blockade of the right bundle of the bundle, signs of overload of the right atrium.
The radiographically pulmonary picture is depleted, the size of the heart depends on the magnitude of the right-left vent (if any) and on the congestion of the heart cavities.
The most noticeable echocardiographic sign of heart disease is an increase in the right ventricle and a thickening of the interventricular septum. In addition, a violation of the opening of the pulmonary valve is revealed, the thickened valves of which during the systole arched into the enlarged pulmonary arch. Doppler echocardiography shows turbulent blood flow on the valve, the presence of a pressure gradient.
Cardiac catheterization and angiocardiography are shown only in cases of balloon valvuloplasty.
Differential diagnosis should primarily be performed with an atrial septal defect, since systolic murmur in the second intercostal space in the left in both cases is due to a narrowing of the right ventricular outflow tract.
What do need to examine?
How to examine?
Treatment of isolated pulmonary artery stenosis
Drug treatment is ineffective. In newborns, prostaglandins may be used to maintain pulmonary blood flow. Surgical treatment involves transluminal balloon valvuloplasty. Intervention can be carried out at any age, and also repeatedly. Operations on the open heart are indicated for severe dysplasia of the valve, the presence of correction requiring infundibular stenosis.
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