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December 11, 2016 00:05

Pulmonary stenosis : Causes, Symptoms , Diagnosis, Treatment

Pulmonary stenosis - narrowing of the right ventricular outflow tract, causing obstruction to blood flow from the right ventricle into the pulmonary artery during systole.

Pulmonary stenosis is most often congenital, and is mostly found in children.Pulmonary stenosis may be valvular or subvalvular directly localized in the outflow tract (subklapanny).Rarer causes include Noonan syndrome (familial syndrome, Turner's syndrome-like, but without chromosomal defect) and carcinoid syndrome in adults.

Many children have no clinical symptoms for many years.Such patients do not seek medical attention until adulthood.When symptoms appear, they resemble aortic stenosis (syncope, angina, shortness of breath).Visible and palpable signs reflect right ventricular hypertrophy (RV) and include visible swelling of the jugular veins (due to increased atrial contraction in response to hypertrophy of the prostate), precordial bulging of the right ventricle (heart hump) and systolic tremor on the left of the sternum in th

e second intercostal space.Auscultation I heart sound (S1) normal, II heart sound (S2) is split and extended because of the long exile of pulmonary [lung component S3 (R) delayed].When failure and hypertrophy of the right ventricle III and IV heart sounds (S3 and S4) is sometimes heard in the fourth intercostal space to the left of the sternum.It is believed that a click in congenital pulmonary stenosis is the result of abnormal ventricular wall stress.Clicking appears in early systole (very close to S2) and is not subject to hemodynamic changes.Rough narastayusche-decreasing ejection murmur best heard on the left of the sternum in the second (valve stenosis) or fourth (subvalvular stenosis of the pulmonary trunk) intercostal space through a stethoscope diaphragm, when the patient leans forward.Unlike noise noise aortic stenosis pulmonary stenosis is not radiating and increasing the noise component is extended with the progression of stenosis.The noise gets louder during the Valsalva maneuver, and during inspiration;the patient has to get up to this phenomenon has become more audible.

diagnosis is established using Doppler echocardiography, which data can be characterized as minimal stenosis (peak gradient of 80 mm Hg. Art.).ECG data is always promote partial assessment.They may be normal or reflect hypertrophy of the right ventricle or the blockade of the right bundle branch block.Right heart catheterization is prescribed only in cases of suspected obstruction of two levels (the valve and subvalvular) when the clinical and echocardiographic findings are different, and before surgery.

forecast without treatment is generally good and improving with adequate medical attention.Treatment includes balloon valvuloplasty, given to patients with symptoms of pulmonary stenosis and patients without clinical symptoms, with normal systolic function and a peak gradient of & gt;40-50 mm Hg.Art.