Pulmonary valve stenosis echocardiogram

Pulmonary valve stenosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Echocardiography

2D Echocardiography

• Thickened leaflets with systolic bowing in valvular stenosis.
• Difficult to distinguish between valvular, sub valvular and supra valvular stenosis with 2D echocardiography.
• Post stenotic pulmonary artery dilatation can be visualised sometimes.

Doppler Echocardiography

• Ante grade velocity increased with corresponding maximum and mean pressure gradients.
• Pulmonary valve area can be calculated using the continuity equation.

Pulmonary Valve Area = (Cross sectional area_RVOT * VTI_RVOT)/ VTI_PV

• The site of obstruction can be difficult to diagnose by 2D echo. Cautious use of colour flow mapping and PW Doppler can pin point the location of obstruction.

• Pulmonic Stenosis 1

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• Pulmonic Stenosis 2

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• Pulmonic Stenosis 3

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Severity Assessment

Severity of pulmonic stenosis

Severity	mild	moderate	severe
Valve area	>1.0	1- 0.5	<0.5
Peak gradient (mm Hg)	<10-25	25-40	>40

ACC / AHA Guidelines - Recommendations for Evaluation of the Unoperated Patient. (DO NOT EDIT)

Class I

"1.Two-dimensional echocardiography-Doppler, chest x-ray, and ECG are recommended for the initial evaluation of patients with valvular PS.(Level of Evidence: C) "

"2.A follow-up physical examination, echocardiography-Doppler, and ECG are recommended at 5-year intervals in the asymptomatic patient with a peak instantaneous valvular gradient by Doppler less than 30 mm Hg.(Level of Evidence: C) "

"3.A follow-up echocardiography-Doppler is recommended every 2 to 5 years in the asymptomatic patient with a peak instantaneous valvular gradient by Doppler greater than 30 mm Hg.(Level of Evidence: C) "

Class III

"1.Cardiac catheterization is unnecessary for diagnosis of valvular PS and should be used only when percutaneous catheter intervention is contemplated.(Level of Evidence: C) "

References

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