Pulmonary stenosis is a condition where the pulmonary valve, the valve between the right ventricle and the pulmonary artery, is too small, narrow or stiff.

Symptoms of pulmonary stenosis depend on the size of the narrowed pulmonary valve. If symptoms are mild, pulmonary stenosis may not require treatment. Children with more severe pulmonary stenosis will need a procedure to fix the pulmonary valve so blood can flow properly to the lungs. If the stenosis is extreme, a baby may need an emergent procedure to open the valve.

The pulmonary valve controls the flow of blood as it leaves the right ventricle of the heart and keep it flowing forward to the lungs. It opens to let blood move ahead, then quickly closes to keep it from flowing backward.

In pulmonary stenosis, the pulmonary valve is too small or too narrow and can’t open all the way. This causes the right ventricle to pump harder to send blood out to the lungs. Over time, this can cause the right ventricle to thicken and strain the heart.

The specialists at Norton Children’s Heart Institute — the leading providers of pediatric heart care in Louisville and Southern Indiana — can help your child with pulmonary stenosis.

The board-certified and fellowship-trained specialists at Norton Children’s Heart Institute, affiliated with the University of Louisville, have the skill and experience to provide a pinpoint diagnosis and know when pulmonary stenosis requires surgery and when other treatment options can be pursued.

The Society of Thoracic Surgeons has ranked Norton Children’s Heart Institute’s pediatric heart care among the best in the region. Norton Children’s has a network of outreach diagnostic and treatment services throughout Kentucky and Southern Indiana.

Pulmonary stenosis symptoms

Many people with pulmonary stenosis have no symptoms. Others have mild symptoms that usually don’t become bothersome.

Symptoms of severe pulmonary stenosis can include:

• Being very tired
• In newborns, a bluish tint to the skin (cyanosis) caused by blood that is low in oxygen
• Chest pain
• Fainting
• Palpitations (sensation of rapid or irregular heartbeat)
• Poor weight gain
• Shortness of breath
• Swollen abdomen

In babies, pulmonary stenosis happens when a baby’s heart doesn’t develop the way it should during pregnancy. Doctors don’t know why this happens. the cause of pulmonary stenosis is unknown.

Diagnosing pulmonary stenosis

Doctors can identify pulmonary stenosis before birth. This allows treatment to occure immediately after birth. A fetal echocardiogram (fetal echo) uses sound waves to create a moving picture of the heart. This helps doctors see how the baby’s heart looks and works while still in the mother’s womb.

Norton Children’s Heart Institute offers fetal echo tests at six locations in Ashland, Lexington, Louisville, Owensboro and Paducah to examine the structure of your baby’s heart.

In other cases of pulmonary stenosis, the doctor may hear a heart murmur.— a specific “whooshing” sound — because of the uneven blood flow through the narrowed pulmonary valve. Your child then may be sent to a pediatric cardiologist. To diagnose your child’s condition, the pediatric cardiologist may use:

• Echocardiogram (echo): This test uses sound waves (ultrasound) to produce images of the heart and blood vessels’ structures on a screen. It can show structure of the heart and ductus arteriosus and also the function of the heart. Norton Children’s Heart Institute has 28 tele-echo locations throughout Kentucky and Southern Indiana.
• Chest X-ray: This shows pictures of the heart and lungs, and can show heart and lung issues, including extra blood flow or fluid in the lungs.
• Electrocardiogram (ECG or EKG): A test that checks the heart’s electrical activity to show damage or irregular rhythms.
• Heart catheterization: This invasive procedure studies the structure, function, and provides direct pressure measurements of the heart.

Pulmonary stenosis treatment

In some cases, pulmonary stenosis doesn’t need to be treated. In severe cases, the pulmonary valve will need to be fixed or replaced.

Many types of procedures can be used to repair or replace the severely stenosed pulmonary valve. Some cases of pulmonic stenosis can be treated with a balloon valvuloplasty during heart catheterization. With this procedure, a doctor threads an unopened balloon through the pulmonary valve and inflates it to open the valve.

Other children may need a valve replacement which involves implanting an artificial valve or a valve from a donor.

To decide what treatment to use, doctors consider:

• Child’s age and size
• How well other valves in the heart are working
• Location of the narrowing and the amount of narrowing
• Whether the child has had previous heart surgery
• Whether the child has other medical conditions

Your pediatric cardiologist and pediatric cardiothoracic surgeon at Norton Children’s Heart Institute will be able to discuss with you all the different options of replacement valves in order to find which option is best to fit your needs.

Pulmonary stenosis complications and follow-up

Following treatment for pulmonary stenosis, patients will continue to follow-up with their pediatric cardiologist. Reasons for this include reoccurrence of pulmonary stenosis from scar tissue that forms after a valvuloplasty or a valve replacement that doesn’t grow as the child gets bigger. Some children might need several procedures in their lifetime to keep the valve functioning properly.

After treatment, most children can enjoy regular activities after their recovery. Children and teens with moderate or severe pulmonary stenosis should talk with their cardiologist before playing competitive sports or being very physically active.

Why Norton Children’s Heart Institute?

Norton Children’s Heart Institute, affiliated with the University of Louisville, is a comprehensive pediatric heart surgery, heart failure and heart transplant program serving Kentucky, Southern Indiana and beyond.

The goal of the full-service Norton Children’s Heart Institute is to provide care for the child and the whole family. Our specialists are prepared to repair even the most complex congenital and acquired heart conditions.

Our heart team includes:

• Pediatric cardiothoracic surgeons
• Pediatric transplant surgeons
• Pediatric cardiologists
  • Fetal cardiologists
  • Adult congenital heart cardiologists
  • Heart failure/heart transplant cardiologists
  • Pediatric electrophysiologists
  • Pediatric cardiac catheterization cardiologists
• Pediatric cardiovascular anesthesiologists
• Pediatric intensive care physicians
• Cardiac critical care nurses
• Critical care pharmacists
• Family support team
• Child life specialists
• Rehabilitation specialists
• Social workers