This protocol applies to symptomatic moderate or severe valvular pulmonic stenosis where balloon valvotomy is not feasible or has failed, and specifically in the setting of associated severe tricuspid regurgitation — as well as other anatomical presentations that preclude catheter-based repair.
Surgical repair is recommended for symptomatic patients with moderate or severe valvular pulmonic stenosis who are ineligible for balloon valvotomy or in whom it has failed. Surgery is also preferred for most dysplastic pulmonary valves and when there is associated severe tricuspid regurgitation or other conditions warranting operative intervention. This includes patients with severe pulmonary stenosis accompanied by a hypoplastic pulmonary annulus, severe pulmonary regurgitation, sub-valvular pulmonary stenosis, or supravalvular pulmonic stenosis.
The primary intervention in this setting involves pulmonary valve replacement — available in both surgical and transcatheter forms, with multiple valve options whose selection depends on anatomy and clinical context. The full decision algorithm, specific valve options, and procedural criteria are available in the complete protocol.
Alleviation of right ventricular dilatation and dysfunction, and resolution of related symptoms.
Otherwise, surgical repair is recommended in case of symptomatic patients with moderate or severe valvular pulmonic stenosis who are ineligible for balloon valvotomy or who have failed it.
This includes patients with severe PS and an associated hypoplastic pulmonary annulus, severe pulmonary regurgitation (PR), sub-valvular PS or supravalvular pulmonic stenosis.
Surgery is also preferred for most dysplastic valves and when there is associated severe tricuspid regurgitation or other cardiopathy that warrants operative intervention.
At last, pulmonary valve replacement may be necessary when there is a failure with repair or severe residual symptomatic PR, in particular in cases with marked dysplasia of the pulmonary valve or significant hypoplasia of the annulus.
Pulmonary valve replacement is also the main reintervention in patients with PS who have previously undergone valvotomy with subsequent PR and/or residual PS.
The main available valves for transcatheter replacement are the Melody Valve and the Edwards SAPIEN XT and S3 Valves.
Pulmonary valve replacement, if appropriately implemented, effectively alleviates right ventricular dilatation and dysfunction and resolves the related symptoms.
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