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What is the role of balloon valvuloplasty in pulmonary stenosis ?

What is the role of balloon valvuloplasty in pulmonary stenosis ? 

Relief of valvular stenosis can be accomplished easily and safely with percutaneous balloon valvuloplasty (Am J Cardiol 1990; 65: 775) and a delay in intervention offers no advantage.

Balloon valvuloplasty, the procedure of choice, is usually successful, provided the valve is mobile and pliant; its long-term results are excellent.

The secondary hypertrophic subpulmonary stenosis that may occur with valvular stenosis usually regresses after successful intervention.

In a series of 100 patients, balloon dilatation resulted in a significant reduction in the transvalvular gradient. which was maintained at 12 months' follow-up (lnt J Cardio11988; 21: 33542).

How would you manage a patient with pulmonary stenosis ?

How would you manage a patient with pulmonary stenosis ? 

• Mild valvular pulmonary stenosis: these patients are usually asymptomatic. Survival among such patients is excellent (94% are still alive 20 years after diagnosis) and therefore they do not require surgical correction. It is important that patients with mild valvular stenosis who are undergoing elective dental or surgical procedures should receive antibiotic prophylaxis against infective endocarditis.

• Severe stenosis: the stenosis should be relieved, since only 40% of such patients do not require any intervention by 10 years after diagnosis.

• Moderate pulmonary stenosis has an excellent prognosis with either medical or interventional therapy, lnterventional therapy is usually recommended, since most patients with moderate pulmonary stenosis eventually have symptoms requiring such therapy. Valve replacement is required if the leaflets are dysplastic or calcified or if marked regurgitation is present.

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