Pulmonary stenosis is primarily a congenital condition that may arise from various factors including rheumatic fever and carcinoid syndrome, and can lead to right ventricular hypertrophy and heart failure. Symptoms can range from mild (asymptomatic) to severe, requiring treatments such as valvotomy in critical cases. Pulmonary regurgitation, the most common acquired pulmonary valve issue, typically presents with a diastolic murmur and usually necessitates no treatment.

1. Pulmonary Stenosis
M. Jude Nilshan Fernando
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2. Pulmonary stenosis
• Usually a congenital lesion
• May rarely result from
– Rheumatic fever
– From the carcinoid syndrome
• Congenital PS may be associated with
– Intact ventricular septum
– Or with a ventricular septal defect (Fallot’s
tetralogy)
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3. Pulmonary stenosis
• May be
– Valvular
– Subvalvular
– Supravalvular
• Multiple congenital pulmonary arterial
stenosis
– Due to infection with rubella during
pregnancy
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4. Symptoms and signs
• Obstruction of R ventricular emptying
– R/ ventricular hypertrophy
– & leads to R/ atrial hypertrophy
• Severe pulmonary obstruction
– May be impartible with life
• Lesser degree of obstruction
– Fatigue
– Syncope
– Symptoms of R/ heart failure
• Mild pulmonary stenosis may be asymptomatic
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5. Physical signs
• Harsh mild systolic ejection murmur
• Best heard on inspiration
• To the L/ of the sternal to the 2nd IC
space
• Murmur is often associated with a trill
• Pulmonary closure sound usually delay and
soft
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6. Physical signs
• There may be pulmonary ejection sound
if the obstruction is valvular
• When the PS is moderately severe
– R/ ventricular 4th sound
– Prominent jugular venous ‘a’ wave
– R/ ventricular heave may be felt
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7. Investigations
• Chest X ray
– Prominent pulmonary artery owing to post-
stenotic dilation
• ECG
– Demonstrate both R/ atrial & R/ hypertrophy
• Doppler echocardiogram is the
investigation of choice
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8. Treatment
• Severe cases need pulmonary valvotomy
– Balloon valvotomy
– Direct surgery
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9. Pulmonary regurgitation
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10. Pulmonary regurgitation
• Most common acquired lesion of the pulmonary
valve
• Results from dilation of the pulmonary valve
ring,
• Which occurs with pulmonary hypertension
• Characterised by decrescendo diastolic
murmur,
• Beginning with P2
• Difficult to distinguish with murmur of AR
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11. Pulmonary regurgitation
• No symptoms
• Treatment is rarely nessesary
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