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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The clinical signs for pulmonary stenosis are: Ejection systolic murmur in the second left intercostal spaceA delayed soft pulmonary component to the second heart soundPulmonary ECFourth heart soundProminent A wave in the venous pressure and RVH
Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
7.3. Pulmonary oedema occurs in which of the following?Smoke inhalation in a fire.Transfusion reaction.Sea water drowning.Heart failure complicating isolated pulmonary stenosis.Pneumonia.
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Pulmonary valve stenosis (PS) accounts for 7%–10% of congenital heart defects, and typically occurs in isolation. The pulmonary valve may be fused and have an appearance of “doming” on the TTE or may be dysplastic with thickened leaflets. Pulmonary stenosis results in right ventricular pressure overload. The treatment of choice for pulmonary stenosis is balloon valvuloplasty. Dysplastic valves may require surgical valvotomy if valvuloplasty is unsuccessful. Pulmonary regurgitation is a common sequela of surgical valvotomy and may require reintervention with a pulmonary valve replacement later in life.
Interventions in Congenital Heart Disease: A Review of Recent Developments: Part II
Published in Structural Heart, 2021
Similar to fetal AS, right ventricular outflow tract obstruction from critical pulmonary stenosis (CPS) or pulmonary atresia with an intact ventricular septum (PA/IVS) results in progression to right ventricular dysfunction and hypoplasia with or without co-existing coronary artery abnormalities. Despite improvements in postnatal management, PA/IVS carries a significant risk of morbidity and mortality.118–120 Fetal pulmonary valvuloplasty offers the potential for improved right ventricular growth, increasing the likelihood of biventricular outcome after birth. Published outcomes of pulmonary valvuloplasty for CPS or PA/IVS are comparatively fewer than for FAV. Data from the IFCIR (n = 16), Linz (n = 35), and Boston (n = 10) groups documented technical success from 60% to 69%, and a biventricular outcome was achieved in 38% to 65% of these cohorts.109,121,122 Results from the Linz group showed significantly increased RV dimensions and filling time acutely, and limited longitudinal data support continued RV growth until birth.121
Preventing disease progression in Eisenmenger syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
Ana Barradas-Pires, Andrew Constantine, Konstantinos Dimopoulos
Standard echocardiographic markers of PH may not be applicable to some CHD morphologies. For example, where there is right ventricular outflow tract obstruction, a raised tricuspid regurgitation gradient reflects the severity of obstruction and right ventricular systolic pressure, not pulmonary arterial pressure; in unrepaired pulmonary atresia or univentricular circulation, the tricuspid regurgitation gradient reflects systemic ventricular pressures; in transposition of the great arteries after atrial switch (Mustard or Senning) operation, the tricuspid regurgitation gradient reflects the pressure in the systemic right ventricle, while the mitral valve regurgitation gradient can provide information on pulmonary artery pressure in the absence of pulmonary stenosis. In such cases, expertise is required to identify markers of PH and refer patients for further investigations (i.e. right heart catheterization).
“Unexpected findings in the work-up of abdominal pain”
Published in Acta Cardiologica, 2020
Dupuis Fabien, Dupont Michaël, Postolache Adriana, Schroeder Erwin, Seldrum Stéphanie
To complete the assessment of the suspected pulmonary stenosis, a right heart catheterisation was performed. Ventriculography showed an extrinsic compression of the RV outflow tract (Figure 1(B) and see Supplementary data online, Movie S1–S2) with normal pulmonary valve and pulmonary artery. Haemodynamic assessment displayed a right atrium pressure of 9 mmHg, a RV systolic pressure of 70 mmHg, a mean pulmonary artery pressure of 21 mmHg (systolic 28 mmHg) and low cardiac output of 2.1 L/min. While removing catheter, gradient between pulmonary artery and right ventricle was measured at 54 mmHg. An attempt for left catheterisation via femoral artery revealed complete interruption of the descending aorta before the cross, hitherto unknown. Radial arteries were considered too thin, and no other attempt for left catheterisation was undertaken.