2. Introduction.
• Obstructive defects occurs when heart valves,
arteries or veins are abnormally narrow or
blocked.
• Common defects-
– Pulmonary stenosis.
– Aortic stenosis.
– Coarctation of the aorta.
3. Pulmonary stenosis.
• A dynamic or fixed obstruction of flow from
the right ventricle to pulmonary artery.
• Usually diagnosed in children.
• Clinical features.
– Asymptomatic.
– Poor exercise tolerance.
– Right ventricular failure/cyanosis.
4. Pulmonary stenosis.
• Physical signs.
– Ejection systolic.
– Best heard at upper left sternal edge. Murmur radiates
backwards.
– Thrill may be present
– Ejection click best heard at the upper left sternal edge
– When severe, there is a prominent right ventricular impulse
(heave).
• Investigations.
– CXR.
– ECG – Right ventricular hypertrophy – Up right T wave in V1.
• Management.
– Transcatheter ballon dilation.
5. Aortic stenosis.
• The aortic valve leaflets are partly fused
together giving a restrictive exit from the left
ventricle.
• Clinical features:
– Asymptomatic murmur.
– Reduced exercise tolerance.
– Chest pain of exertion.
– Syncope.
6. Aortic stenosis.
• Physical signs.
– Small volume, slow rising pulse.
– Carotid thrill – always.
– Ejection systolic.
– Best heard at the upper right sternal edge. Radiates to neck.
– Delayed and soft aortic second sound.
– Apical ejection click.
• Investigation.
– CXR.
– Doppler Echo – used to estimate pressure across valves.
– ECG.
• LBB due to calcification.
• LVH.
• Poor R wave progression.
• Management.
– Surgical – valve replacement (prosthetic & metal).
– Balloon dilation used to alleviate stenosis.
7. CoA.
• CoA is where there is a narrowing in the aorta
in the region of the ductus arteriosus. L-R
shunt. (10-20% in Turner’s syndrome).
• Three (3) types.
– Proximal to ductus arteriosus.
– At the ductus ateriosus.
– Distal to the ductus arteriosus.
8. CoA.
• Clinical features.
– Breathless, grey and collapsed with hepatomegaly.
– Pulses are stronger in arms than legs.
– B.P is lower in legs than arms. (Upper body HTN &
Lower body HTN).
– No murmurs.
• Management.
– Prostaglandin E is given to reopen duct.
– Manage HTN.
– High pressure ventilation.
– Surgical balloon treatment + stenting.
