Valvular Heart Disease：瓣膜性心脏病.pptVIP

Pulmonary Stenosis Etiology: Congenital the commonest cause: +VSD Fallot’s Others: rheumatic fever carcinoid syndrome. Multiple congenital pulmonary arterial stenoses are usually due to infection with rubella during pregnancy Types of PS valvular, subvalvular or supravalvular.. Symptoms and signs of PS  Mild pulmonary stenosis may be asymptomatic Severe pulmonary obstruction may be incompatible with life. The obstruction to RV emptying RVH R Atrial Hypertrophy right heart failure.. In lesser degrees of obstruction fatigue, syncope. Pulmonary Stenosis: Signs P2 sound is usually delayed and soft a Mid systolic thrill Murmur: harsh mid-systolic ejection murmur, best heard on inspiration, to the left of the sternum in the second intercostal space. Other findings: pulmonary ejection sound (may be ) if the obstruction is valvular. A right ventricular fourth sound and a prominent jugular venous a wave are present when the stenosis is moderately severe. A right ventricular heave (sustained impulse) may be felt. Pulmonary Stenosis: Investigations Chest X-ray The chest X-ray usually shows a prominent pulmonary artery owing to post-stenotic dilatation. ECG The ECG demonstrates both right atrial and right ventricular hypertrophy, although it may sometimes be normal even in severe pulmonary stenosis. Echocardiogram Doppler is the investigation of choice. Cardiac catheterization The passage of a catheter through the right heart allows the level and degree of the stenosis to be established by measuring the systolic pressure gradient. PS: Treatment Treatment of severe pulmonary stenosis requires: pulmonary valvotomy (balloon valvotomy or direct surgery). Pulmonary Regurgitation  This is the most common acquired lesion of the pulmonary valve. Etiology of PR: It results from dilatation of the pulmonary valve ring, which occurs with pulmonary hypertension. Diagnosis: It is charact