Information on Kids Health
The pulmonary valve directs blood from the right ventricle into the pulmonary artery (the large vessel that carries oxygen-poor blood to the lungs). If the pulmonary valve is narrowed, or stenotic, less blood flows from the right ventricle to the pulmonary artery and on to the lungs.
Concerns and Symptoms
Pulmonary stenosis can occur in the valve itself or in the muscles just underneath the valve. The more severe the narrowing, the more symptoms the child will have, and the earlier the disorder will be detected.
Over time, the right ventricle has to work harder to pump blood through the narrow pulmonary valve. The heart muscle may enlarge and become less able to pump blood to the lungs effectively, and the child may become cyanotic, or blue.
Infants with severe pulmonary stenosis will be critically ill shortly after birth. Children with moderate pulmonary stenosis may show symptoms of fatigue, shortness of breath, heavy or rapid breathing, or fluid retention. Older children and adolescents may have a heart murmur.
In some cases, pulmonary valve stenosis can be treated by inserting a balloon through the narrow area and inflating it, thereby opening up the stenosis. This type of procedure is performed by interventional cardiologists.
In other cases, surgical repair of the valve is necessary. The operation is performed under general anesthesia, which means the child will be asleep during surgery.
First the surgeon makes a vertical incision in the front of the chest, opens the breastbone, and exposes the heart. Blood from the heart is redirected to a bypass machine. The bypass machine does the job of the heart and lungs during the operation.
Then the surgeon repairs the pulmonary valve to allow blood to pass through more easily. If the stenosis is caused by tissue or muscles underneath the pulmonary valve, these may be removed as well.
After the valve is repaired and the heart closed, the surgeon shuts down the heart-lung bypass machine, and the heart starts beating again. The surgeon then closes the breastbone and chest incision and applies bandages to the incision site.