Introduction
Pulmonic stenosis is a valvular abnormality that obstructs blood flow between the right ventricle and the pulmonary arteries
Risk factors: German measles, rheumatic fever, Noonan sy1ndrome, carcinoid syndrome
Untreated severe stenosis may result in RV failure
Symptoms & Signs
-mild cases are asymptomatic
-moderate to severe cases may cause dyspnea on exertion, syncope, chest pain, RV failure
-cyanosis and clubbing if parent foramen ovale or ASD exists
-a loud, harsh, high pitched systolic ejection murmur, a prominent thrill present in the left second and third interspaces parasternally
-the murmur radiates toward the left shoulder and increases with inspiration
-this is the only right-sided auscultatory event that decreases with inspiration
-a loud ejection click can be heard to precede the murmur
-the pulmonary component of S2 may be diminished, delayed, or absent
-Noonan syndrome: short stature, web neck, mental retardation, antimongoloid slanting of the eyes, hypogonadism
Diagnosis
ECG: right ventricular hypertrophy with right-axis deviation, prominent R waves in the right precordial leads
Chest radiography: dilated main and left pulmonary arteries, post-stenotic dilatation; greater vascular perfusion of the left lung than the right base (Chen sign)
Echocardiography: diagnostic tool of choice
Treatment
-Percutaneous balloon valvuloplasty, Surgical commissurotomy or pulmonary valve replacement
-Endocarditis prophylaxis in certain cases