Severity determines treatment. Patients with very mild obstruction and no symptoms may not require treatment. For others, pulmonary stenosis may need to be be treated with a procedure called a valvuloplasty. This procedure is minimally invasive, which means it requires only a small incision. A more severe problem may require an open-heart operation, which is major surgery.
Children and adults whose pulmonary valves are still flexible may be treated with a balloon valvuloplasty, a non-surgical procedure in which a catheter — a thin, flexible, plastic tube — is inserted into the heart via blood vessels from the leg. A balloon at the tip of the catheter is inserted into the narrow opening in the valve and then inflated to stretch the valve opening and separate the valve leaflets. This is usually very successful and permanent. If, however, the valve is unusually thick, then the balloon procedure is unlikely to be successful and the surgeon will have to open up the valve with a scalpel.
In adults with severe stenosis, the valve is often stiff and calcified, and treatment is more likely to include surgical replacement with either a manufactured valve or a valve from an animal, usually a pig. Another surgical repair involved removing obstructive tissue below the valve, which may be done in conjunction with valve replacement. Studies indicate that surgical valvotomy has a 25-year survival rate of 95 percent, or about the same as the normal population.
Most patients who have been treated surgically or with balloon valvuloplasty in childhood will have normal lives. They usually do not require continuous antibiotic treatment but it may be recommended for some people who have additional complications. The likelihood of requiring a repeat procedure is very low — 5 percent at 25 years. However, it is recommended that all patients be evaluated by a cardiologist specializing in adult congenital heart disease at least once. At that time, an echocardiogram should be performed. Thereafter, yearly physical examinations are recommended with repeat echocardiogram should there be a change in the physical examination or new symptoms.
Reviewed by health care specialists at UCSF Medical Center.
Cardiovascular Care and Prevention Center at Mission Bay
535 Mission Bay Blvd. South
San Francisco, CA 94158
Phone: (415) 353-2873
Fax: (415) 353-2528