Pulmonary stenosis is a condition where there is obstruction of blood flow from the right ventricle to the pulmonary artery. This obstruction can occur at the pulmonary valve itself, the area below the valve known as the infundibulum, or in the pulmonary artery above the valve. Common symptoms include a heart murmur, fatigue, shortness of breath, and chest pain. Echocardiography is used to diagnose pulmonary stenosis and determine its severity by measuring the thickness of the valve, the pressure gradient across the valve, and effects on the right ventricle like hypertrophy. Severity is classified as mild, moderate, or severe based on the peak gradient and valve area.

1. PULMONARY STENOSIS
Made by:- Muskan Kapoor

2. INTRODUCTION
● Pulmonary stenosis is a condition characterized by
obstruction to blood flow from the right ventricle to the
pulmonary artery.
● This obstruction is caused by narrowing (stenosis) at one or
more points from the right ventricle to the pulmonary
artery.
● Areas of potential narrowing include thickened muscle
below the pulmonary valve, stenosis of the valve itself, or
stenosis of the pulmonary artery above the valve.
● The most common form of pulmonary stenosis is
obstruction at the valve itself, referred to as pulmonary
valvar stenosis.

3. TYPES OF PS
● Valvular :- congenital
e.g. Noonan syndrome ,
TOF
● Supravalvular
(peripheral) - stenosis of
main PA
● Subvalvular (
infundibular) - mostly
congenital with VSD

4. SIGNS & SYMPTOMS
● Heart murmur
● Fatigue
● Shortness of breath
● Chest pain
● Fainting

5. ECHOCARDIOGRAPHY
● 2D echo:- thickening and doming of the valve.
- RV hypertrophy with marked increased trabeculation of
the RV walls.
- In severe PS septal flattening and RV enlargement is
seen.
- Post stenotic dilation of PA.
● M mode:- exaggerated “a” wave amplitude (6 mm ) of PV
during diastole.

7. ● Doppler :- systolic gradient across PV is
low .
- Dynamic infundibular stenosis can be
distinguished from valvular stenosis is
seen.
- Peak transvascular gradient is calculated.
● Severe PS - RV systolic pressure as
percentage of systemic systolic pressure
greater than or equal to 100% and
transvascular pressure gradient >equal to
80 mmHg
Severity of PS Peak gradient Valve area( cm square)
Mild <25 mmHg >1.0
Moderate 25-40 mmHg 0.5-1.0
Severe >40 mmHg <0.5