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Treatments and drugs
By Mayo Clinic staffSome cases of pulmonary stenosis are mild and don't require treatment except for routine checkups. However, if your case is more serious, you may undergo 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.
Balloon valvuloplasty
This technique 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 most common side effect of a balloon valvuloplasty is valve regurgitation, in which the pulmonary valve leaks after the balloon is in place. But the benefits associated with the procedure usually outweigh the risk of valve regurgitation. Also, as with most procedures, there is a risk of bleeding, infection or blood clots. Serious complications are rare and most people can expect to return to normal activity afterward.
Open-heart surgery
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.
Preventive antibiotics
In the past, people with heart valve problems were advised to take antibiotics before certain dental and surgical procedures, to prevent bacteria from causing an infection of the inner lining of the heart (infective endocarditis).
The American Heart Association recently updated these recommendations, and antibiotics are no longer recommended for people who have only pulmonary stenosis. Instead, antibiotics are reserved for people at high risk of serious complications of infective endocarditis, such as those who have other heart conditions or artificial valves, or who've had repair with prosthetic material.
These new recommendations are based on evidence that random germs appear to cause infective endocarditis more frequently than do routine dental or medical procedures, and that widespread use of antibiotics carries a small risk of allergic reaction and may contribute to growing antibiotic resistance. A more effective preventive strategy may be to practice good oral hygiene and see your dentist for regular checkups.
If you've had your pulmonary valve replaced, you may still need preventive antibiotics before dental and other procedures. Talk to your doctor for specific recommendations in your case.
