Pulmonary stenosis

Dr. Rekha Pathak (Sr. Scientist)Division of Surgery,Indian Veterinary Research Institute, Izatnagar, Bareilly, India

Pulmonary stenosis

Common as PDA, Bulldogs, terriers

and chihuahua. Pulmonary

stenosis - first 8 weeks of pregnancy.

Pulmonary valve: a valve that has

leaflets that are partially fused together.

a valve that has thick leaflets that do not open all the way.

the area above or below the pulmonary valve is narrowed.

There are four different types of pulmonary stenosis:

valvar pulmonary stenosis - the valve leaflets are thickened and/or narrowed-fusion of valves- leave a small eccentric hole in middle 

supravalvar pulmonary stenosis - the pulmonary artery just above the pulmonary valve is narrowed

subvalvar (infundibular) pulmonary stenosis - the muscle under the valve area is thickened, narrowing the outflow tract from the right ventricle

branch peripheral pulmonic stenosis - the right or left pulmonary artery is narrowed, or both may be narrowed

Why is pulmonary stenosis a concern? Mild -no symptoms. moderate to severe -Problems can occur

Pathophysiology

The right ventricle - work harder It fails to pump forward efficiently. Pressure builds up in the right

atrium Fluid retention and swelling may

occur.

There is a higher than average chance of developing an infection in the lining of the heart known as bacterial endocarditis.

What are the symptoms of pulmonary stenosis?

The following are the most common symptoms of pulmonary stenosis.

heavy or rapid breathing shortness of breath Fatigue,fainting rapid heart rate swelling in the feet, face, eyelids,

and/or abdomen Cyanosis in terminal stages Severe cases: Distended jugular

veins, hepatomegaly, ascites

How is pulmonary stenosis diagnosed?

A heart murmur is simply a noise caused by the turbulence of blood flowing through the obstruction from the right ventricle to the pulmonary artery- left 3rd intercostal space

Delayed closure of pulmonary valve- splitting of II heart sound

chest x-ray – DV- rt. Ventricular hypertrophy

Contrast angiogram:Post stenotic dilatation

Marked outflow tract narrowing(narrowed rt.and left branches)-different from dirofilariasis and left to rt. Shunt where the pulmonary branches are enlarged.

Due to rt.side base enlarged , trachea appears elevated before bifurcation

electrocardiogram (ECG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress.

echocardiogram (echo) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.

Cardiac catheterization –GA- radiopaque catheter- femoral vessels/jugular/carotid – under fluoroscopic guidence.

Pressure difference in PA <Rt. Ventricle.

Repair options include the following: balloon dilation or valvuloplasty

used for valvar, supravalvar, or branch

types of pulmonary stenosis A small, flexible tube (catheter) is inserted

into a blood vessel in the femoral vessel and guided to the inside of the heart. The tube has a deflated balloon in the tip. When the tube is placed in the narrowed valve, the balloon is inflated to stretch the area open.

ValvotomyValvotomy is the surgical release of adhesions that are preventing the valve leaflets from opening properly. This type of procedure is generally not performed, as balloon dilation or valvuloplasty has become more common.

Valvular fusion- Insert valvulotome- purse-string stab incision

4th left intercostal space-reflect left cranial lung lobe- incision on rt. Ventricular outflow

Purse-string- 2-0, silk- conus- 2 cm incision on epicardium – sharp scalpel

Blunt probe- inserted – level of obs.-withdrawn- valvulotome /teat bistoury is put-withdrawn

Record the pressure Close with interrupted sutures

Open technique: Rt. Ventriculotomy: direct visual

repair of stenosis To cut the fusion of cusp upto the

base or attachment Less practiced in veterinary

valvectomy (with or without transannular patch)Valvectomy is the surgical removal of the valve and the widening of the outflow patch to improve blood flow from the right ventricle into the pulmonary artery. Once the individual reaches adulthood, the pulmonary valve is generally replaced

pulmonary valve replacementReplacement of the pulmonary valve is a surgical procedure that is often recommended in adulthood. A tissue valve (pig or human) may be used.