What is Pulmonary Artery Stenosis?
Pulmonary artery stenosis is a defect in which blood flow from the right ventricle to the lungs is obstructed by a narrowing. The narrowing may be at the valve level, below it, or above it. As a result, the right ventricle must work under increased strain.
Pulmonary artery stenosis accounts for 8–10% of all congenital heart defects. It may occur in isolation or in combination with other defects — for example, as part of tetralogy of Fallot.
"Pulmonary artery stenosis frightens parents — but the prognosis for this defect is significantly better than for many others. Stenosis detected early and treated in time ends in complete recovery. The key is not to delay diagnosis."
Degrees of Severity
Stenosis is classified into three grades by pressure gradient:
- Mild stenosis — gradient below 40 mmHg. Often requires no intervention — observation only
- Moderate stenosis — 40–70 mmHg. Requires treatment
- Severe stenosis — above 70 mmHg. Urgent intervention indicated
Symptoms
- Children with mild stenosis are usually asymptomatic
- Shortness of breath and easy fatigue on exertion
- Heart murmur — detected by paediatrician on examination
- Cyanosis in newborns with severe stenosis
- Signs of right heart failure — in severe cases
Treatment Methods
1. Balloon valvuloplasty (catheter method)
Today this is the primary treatment for valvular pulmonary stenosis. A catheter is introduced through a vessel in the groin; a special balloon widens the valve. No chest opening, under anaesthesia, takes 1–2 hours. The child is discharged after 1–2 days.
2. Surgical treatment
For subvalvular and supravalvular stenosis, or when catheter-based treatment is not possible, open surgery is performed. The narrowing is relieved or the valve replaced under cardiopulmonary bypass.
Important: Mild stenosis requires monitoring — it does not mean "it will resolve on its own". Over time stenosis can progress. Regular echocardiographic follow-up is mandatory.
Treatment Outcomes
The success rate of balloon valvuloplasty is 85–95%. Most children make a full recovery and live a normal life. In some cases a repeat procedure may be needed years later — this is a planned, predictable intervention.
Can pulmonary stenosis be seen on echocardiography?
Yes. Doppler echocardiography accurately determines the location, degree of stenosis and right ventricular pressure. It is the primary diagnostic method.
When is catheter intervention performed?
For moderate and severe stenosis — usually from the first months of life. In severe cyanosis in a newborn — immediately. Children with mild stenosis are kept under observation.
Can the child play sport after treatment?
Mild stenosis — usually without restriction. After successful treatment — full activity. Each child is assessed individually.
Can stenosis recur?
Yes, stenosis can recur after balloon valvuloplasty — especially as the child grows. Regular cardiac follow-up is therefore mandatory. The procedure can be repeated if necessary.