Right ventricular outflow tract obstruction pulmonary subvalvular stenosis

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Overview

Anatomy of Pulmonary Valve

Classification

Pulmonary valve stenosis
Pulmonary subvalvular stenosis
Pulmonary supravalvular stenosis
Pulmonary atresia

Pathophysiology

Causes

Differentiating Right ventricular outflow tract obstruction from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

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Cardiac Catheterization

Pulmonary Angiography

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Indications For Surgery

Surgery

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Cost-Effectiveness of Therapy

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Pulmonary artery conduits/Prosthetic Valves

Double-Chambered Right Ventricle

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Associate Editor-in-Chief: Keri Shafer, M.D. [3]

Anatomy

  • There is hypertrophy of the infundibular muscle causing obstruction. [1]
  • The isolated form is rare, more commonly develops in response to an underlying VSD. [2]

Historical Perspective

  • The pulmonary valve and its function of allowing blood to the lungs for nourishment was first described by Hippocrates. [3]
  • Erasistratus, mentioned the function of the pulmonary valve in the unidirectional flow. [4]
  • Galen described the membranes of the valves and named them as "semilunar". [5]
  • Mondino de Luzzi designed the sketch of the pulmonary valves in the anatomical position for the first time.
  • Realdo Colombo described the pulmonary circulation for the first time. [6]
  • Aortic stenosis was probably first described by Lazare Riviere (1589-1655), a French physician in 1663. [7]
  • The first transcatheter aortic valve replacement procedure in the world was performed on 16 April 2002 in a 57-year-old inoperable patient with severe aortic stenosis. The procedure was done by the Interventional Cardiologist Professor Alain Cribier at the Charles Nicolle University Hospital in Rouen, France. [8]

Classification

Based on the severity of the stenosis

Clinical Features

  • Similar to valvar pulmonic stenosis. [9]
  • Aortic stenosis was probably first described by Lazare Riviere (1589-1655), a French physician in 1663. [10] [11]
  • No poststenotic dilation of the pulmonary artery in contrast to valvar pulmonic stenosis.
  • Aortic stenosis was probably first described by Lazare Riviere (1589-1655), a French physician in 1663. [12]

References

  1. Pierpont ME, Basson CT, Benson DW, Gelb BD, Giglia TM, Goldmuntz E; et al. (2007). "Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics". Circulation. 115 (23): 3015–38. doi:10.1161/CIRCULATIONAHA.106.183056. PMID 17519398.
  2. Schmoldt A, Benthe HF, Haberland G, Raffle A, Gray J, MacDonald HR, Ehrhart IC, Parker PE, Weidner WJ, Dabney JM, Scott JB, Haddy FJ, Gatzy JT (September 1975). "Digitoxin metabolism by rat liver microsomes". Biochem. Pharmacol. 24 (17): 1639–41. doi:10.1136/bmj.1.6001.93-a. PMC 5922622. PMID 10.
  3. Roberts WC, Ko JM (July 2008). "Some observations on mitral and aortic valve disease". Proc (Bayl Univ Med Cent). 21 (3): 282–99. doi:10.1080/08998280.2008.11928412. PMC 2446420. PMID 18628928.
  4. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP; et al. (2009). "Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice". Eur J Echocardiogr. 10 (1): 1–25. doi:10.1093/ejechocard/jen303. PMID 19065003.
  5. Waller BF, Howard J, Fess S (1995). "Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part I." Clin Cardiol. 18 (2): 97–102. PMID 7720297.
  6. Pellikka PA, Tajik AJ, Khandheria BK, Seward JB, Callahan JA, Pitot HC, Kvols LK (April 1993). "Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients". Circulation. 87 (4): 1188–96. doi:10.1161/01.cir.87.4.1188. PMID 7681733.
  7. Gur AK, Odabasi D, Kunt AG, Kunt AS (July 2014). "Isolated tricuspid valve repair for Libman-Sacks endocarditis". Echocardiography. 31 (6): E166–8. doi:10.1111/echo.12558. PMID 24661289.
  8. Muraru D, Badano LP, Sarais C, Soldà E, Iliceto S (June 2011). "Evaluation of tricuspid valve morphology and function by transthoracic three-dimensional echocardiography". Curr Cardiol Rep. 13 (3): 242–9. doi:10.1007/s11886-011-0176-3. PMID 21365261.
  9. Nazari S, Carli F, Salvi S, Banfi C, Aluffi A, Mourad Z; et al. (2000). "Patterns of systolic stress distribution on mitral valve anterior leaflet chordal apparatus. A structural mechanical theoretical analysis". J Cardiovasc Surg (Torino). 41 (2): 193–202. PMID 10901521.
  10. Neilson GH, Galea EG, Hossack KF (August 1978). "Thromboembolic complications of mitral valve disease". Aust N Z J Med. 8 (4): 372–6. doi:10.1111/j.1445-5994.1978.tb04904.x. PMID 282850.
  11. Lugiano, CA. (2013). "Aortic stenosis". JAAPA. 26 (11): 46–7. doi:10.1097/01.JAA.0000436518.69169.8e. PMID 24153092. Unknown parameter |month= ignored (help)
  12. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP; et al. (2009). "Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice". J Am Soc Echocardiogr. 22 (1): 1–23, quiz 101-2. doi:10.1016/j.echo.2008.11.029. PMID 19130998.

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