Pulmonary Valvular Stenosis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The heart has four chambers, two upper sections called the right atrium and the left atrium, and two lower sections called the right ventricle and the left ventricle. Parallel to four chambers, the heart has four valves, mitral valve, pulmonary valve, aortic valve, and pulmonary valve. Valves are a crucial part of the heart’s structure. They open and close as the blood passes through them. Cardiac valves mainly regulate the entry and exit of blood into the various chambers of the heart. Each of the heart valves has flaps or leaflets that open and close smoothly. Valves that have three leaflets open and close simultaneously. In order to avoid any type of backflow of blood, the leaflets close, and vice versa is why they open.

Pulmonary valve stenosis or pulmonary valve insufficiency is a cardiovascular disease of the pulmonary valve of the heart in which there is a narrowing in the opening of the valve. The pulmonary valve is also called the pulmonic valve, the right semilunar valve, or the right atrial valve. It is located between the right ventricle and the pulmonary arteries. Mentioned below are the functions of each of the valves of the heart.

• The mitral or bicuspid valves that allow blood to flow smoothly from the left atrium into the left ventricle have two leaflets.

• The tricuspid valve allows blood to flow easily from the right atrium into the right ventricle, and it has three leaflets.

• The aortic valve controls smooth blood flow from the left ventricle to the aorta.

• The pulmonary valve has the primary function of allowing smooth blood flow from the right ventricle into the pulmonary artery with three leaflets.

What Are the Causes of Pulmonary Valvular Stenosis?

Pulmonary valvular stenosis is a cardiovascular disease in which the pulmonary valve of the heart gets stenosed or narrowed due to several etiological factors. The true etiology of pulmonary valvular stenosis remains unknown to date, despite the various studies and clinical trials done on patients suffering from the same. However, mentioned below can be some of the causes of pulmonary valvular stenosis.

• Congenital defect of the heart.

• Carcinoid syndrome.

• Tumors that are present in the digestive system.

• Infection.

• Fusion of the flaps of the pulmonary valve.

• Thickening of the leaflets or cups of the pulmonary valve.

• Right ventricular biopsy.

• Chronic right ventricular pacing.

• Endocarditis.

• Epstein Barr virus.

• Autoimmune conditions.

• Valve ring dilatation.

• Senile degenerative alterations.

• Myocardial infarction.

• Pulmonary hypertension.

• Connective tissue disease.

What Are the Signs and Symptoms of Pulmonary Valvular Stenosis?

Pulmonary valvular stenosis occurs in children as well as in adults. In adults, the development of pulmonary valvular stenosis may be due to an underlying undiagnosed cardiovascular disease. In such cases, the clinical manifestations are parallel to that of the present illness. In the majority of the cases, children are found with a birth defect of the valve, which results in pulmonary valvular stenosis. Mentioned below are the signs and symptoms of pulmonary valvular stenosis.

• Whooshing murmur.

• Lethargy.

• Fatigue.

• Chest discomfort.

• Palpitations of the heart.

• Shortness of breath.

• Cyanosis.

• Loss of consciousness.

• Clammy skin.

• Fever in case of infection.

• Irregular heartbeat.

• Abdominal bloating.

• Generalized edema.

• Dyspnea (shortness of breath).

• Pulmonary hypertension.

• Rapid heart rate.

• Choppy heart sounds.

• Hard breathing.

• Rasping sound while physical examination.

How to Diagnose the Presence of Pulmonary Valvular Stenosis?

Pulmonary valvular stenosis is one of the valvular diseases of the heart that gets detected during childbirth or even during fetal life. The newborn baby, as well as the fetus in the womb, represents turbulent or choppy blood flow. The diagnosis of pulmonary valvular stenosis occurs after a thorough physical examination along with medical history, drug history, and family history of cardiovascular conditions. Due to several advancements in the recent diagnostic sectors, pulmonary valvular stenosis does not go undetected. Mentioned below are the diagnostic tools for pulmonary valvular stenosis:

• An echocardiogram is one of the most accessible diagnostic tools.

• An electrocardiogram is used to detect the location of valvular abnormalities.

• A chest X-ray.

• A complete blood picture.

• Liver function test.

• Blood culture.

• Auscultation with the help of a regular stethoscope.

• Stress test.

• Computed tomography of the heart.

• Cardiac catheterization.

• Magnetic resonance imaging of the heart.

• Transesophageal echocardiogram.

• Doppler echocardiography.

What Is the Treatment of Pulmonary Valvular Stenosis?

Pulmonary valvular stenosis can range from mild to severe, with respect to the intensity of the disease. Mild cases do not have any symptoms, and thus asymptomatic pulmonary valvular stenosis does not require any kind of treatment. A moderate level of pulmonary valvular stenosis may or may not require treatment, and this depends on the clinical manifestations that the patients who are suffering from pulmonary valvular stenosis present with. Mentioned below are the treatment options for pulmonary valvular stenosis:

• Prostaglandin therapy.

• Diuretics.

• Antihypertensive medications.

• Valve replacement.

• Balloon valvuloplasty.

• Open heart surgery.

• Interventional cardiac catheterization.

• Pulmonary valvotomy.

• Transannular patch.

• Partial valvotomy.

• Valvectomy.

• Pulmonary valve replacement.

What Are the Complications of Pulmonary Valvular Stenosis?

Complications and risks are present in any cardiovascular disease as well as any untreated and long-standing disease of the body. Thus, early diagnosis and swift treatment are vital to keep any kind of complications that may pose a threat to the patient’s life at bay. Mentioned below are the complications of pulmonary valvular stenosis:

• Infection of the lining of the blood vessel.

• Arrhythmias of the heart.

• Right ventricular hypertrophy.

• Sudden cardiac failure.

• Risks during labor and childbirth.

• Rheumatic fever.

• Carcinoid tumor.

• Noonan syndrome.

• Rubella virus.

Conclusion

Pulmonary valvular stenosis is a disease of the pulmonary valve of the heart that results in the narrowing of the valve. The direct result of pulmonary valvular stenosis is a decrease in cardiac output and malfunctioning of the cardiovascular system. There are several causes of pulmonary valvular stenosis, but congenital birth defect of the heart remains the most common etiological factor. Treatment modalities are present and are dependent on various manifestations presented by the patients. Following a low-sodium diet along with regular medical checkups are important and are parallel to maintaining one’s body mass index for the longevity of the cardiovascular system, especially the heart and its valvular system.