Treatment of Moderate-to-Severe Isolated Valvular Pulmonic Stenosis with a Domed Pulmonic Valve
Clinical Scenario
This protocol applies to isolated valvular pulmonary stenosis with a domed pulmonic valve, where the peak transvalvular gradient is 36 mmHg or above — moderate stenosis (36–64 mmHg) or severe stenosis (≥64 mmHg) — and pulmonic valve regurgitation is less than moderate. It does not apply when a dysplastic pulmonary valve, hypoplastic pulmonary annulus, sub-valvular or supravalvular pulmonary stenosis, or severe pulmonary regurgitation is present.
First-Line Treatment
AHA/ACC guidelines recommend a percutaneous catheter-based interventional approach as the first-line treatment in this setting, to be carried out as soon as the diagnosis is confirmed — without waiting for symptoms to appear. The complete procedural protocol and stepwise algorithm are available via the link below.
Treatment Goals
Immediately after the intervention, the targets are a rapid reduction in transvalvular gradient, an increase in jet width, and restored free mobility of the pulmonary valve leaflets with reduced doming, together with improvement in right ventricular and tricuspid valve function.
References
- According to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines, in case of domed pulmonic valve with moderate or severe valvular stenosis and less than moderate pulmonic valve regurgitation, balloon valvotomy is recommended.
- Severe stenosis: peak gradient ≥ 64 mmHg; Moderate stenosis: peak gradient between 36 and 64 mmHg.
- Balloon pulmonary valvuloplasty represents the first line of treatment for PS and should be performed as soon as the diagnosis is made, without waiting for the development of symptoms or the patients to reach a certain size.
- The procedure is usually performed through percutaneous femoral access and consists of introducing one or more balloon catheters across the stenotic valve, commonly over an extra-stiff guide wire, and inflating the balloons with diluted contrast material.
- Immediately after the dilatation, a rapid reduction in gradient, increase in jet width, and free mobility of the pulmonary valve leaflets with reduced doming are usually seen with an improvement in RV and tricuspid valve function.
DOI: 10.2147/VHRM.S380240
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