Treatments and drugsBy Mayo Clinic staff
Some cases of pulmonary stenosis are mild and don't require treatment except for routine checkups. However, if your case is more serious, you may need either balloon valvuloplasty or open-heart surgery.
The decision to perform a balloon valvuloplasty or open-heart surgery depends on the extent to which the pulmonary valve is obstructed. Pulmonary stenosis is classified as mild, moderate or severe, depending on a measurement of the blood pressure difference between the right ventricle and pulmonary artery.
This technique, which tends to be the first choice for treatment, uses cardiac catheterization to treat pulmonary valve stenosis. During this procedure, your doctor threads a small tube through a vein in your leg and up to your heart. An uninflated balloon is placed through the opening of the narrowed pulmonary valve. Your doctor then inflates the balloon, opening up the narrowed pulmonary valve and increasing the area available for blood flow. The balloon is then removed.
The most common side effect of a balloon valvuloplasty is valve regurgitation, in which some blood leaks backward through the pulmonary valve after the balloon is in place. But the benefits associated with the procedure usually outweigh the risk of valve regurgitation. As with most procedures, there is a risk of bleeding, infection or blood clots.
Balloon valvuloplasty can't be used for cases of pulmonary stenosis that occur above the pulmonary valve (supravalvular) or below the valve (subvalvular). Open-heart surgery is required for these types of stenoses and occasionally for valvular stenosis.
During the surgery, your doctor repairs the pulmonary artery or the valve to allow blood to pass through more easily. In certain cases, your doctor may replace the pulmonary valve with an artificial valve.
Some people with pulmonary stenosis have other congenital heart defects, and these may be repaired at the time of surgery. As with balloon valvuloplasty, there is a slight risk of bleeding, infection or blood clots associated with the surgery.
- Keane MG, et al. Clinical manifestations and diagnosis of pulmonic stenosis. http://www.uptodate.com/home/index.html. Accessed Sept. 8, 2011.
- Pulmonic stenosis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/cardiovascular_disorders/valvular_disorders/pulmonic_stenosis.html. Accessed Sept. 14, 2011.
- Webb GD, et al. Congenital heart disease. In: Bonow RO, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0398-6..C2009-0-59734-6--TOP&isbn=978-1-4377-0398-6&about=true&uniqId=236798031-10. Accessed Sept. 14, 2011.
- What is heart valve disease? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/hvd/. Accessed Sept. 8, 2011.
- Bittl JA. Natural history and treatment of pulmonic stenosis. http://www.uptodate.com/home/index.html. Accessed Sept. 8, 2011.
- Connolly HM. Carcinoid heart disease. http://www.uptodate.com/home/index.html. Accessed Sept. 8, 2011.
- ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. Washington, D.C. and Dallas, Tex.: American College of Cardiology and American Heart Association. Journal of the American College of Cardiology. 2008;52:e143.