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Acquired Lesions Of The Pulmonary Valve

Updated on January 14, 2014

Pulmonary Valve Lesions

In severe forms of rheumatic heart disease, the pulmonary valve also may be involved as part of the quadrivalvular affection. Bacterial endocarditis may affect congenitally abnormal or even normal pulmonary valve
In severe forms of rheumatic heart disease, the pulmonary valve also may be involved as part of the quadrivalvular affection. Bacterial endocarditis may affect congenitally abnormal or even normal pulmonary valve | Source

Clinical Presentation

The pulmonary valve is only rarely involved by acquired heart disease. In carcinoid syndrome, the pulmonary valve shows fibrous scarring with retraction leading to pulmonary stenosis and regurgitation leading to pulmonary stenosis and regurgitation. In severe forms of rheumatic heart disease, the pulmonary valve also may be involved as part of the quadrivalvular affection. Bacterial endocarditis may affect congenitally abnormal or even normal pulmonary valve. The pulmonary valve may be the seat of tumours such as myxoma or fibroma in rare cases. In Marfan’s syndrome, the valve shows myxomatous degeneration. The valve may be damaged during surgery for tetralogy of Fallot or pulmonary stenosis. Severe pulmonary hypertension resulting from any cause may produce functional pulmonary regurgitation (Graham Steell murmur). Very rarely, pulmonary valve be involved by tuberculosis and syphilis.

Clinical features

Clinical manifestations depend upon the severity of valve involvement and its cause. In quadrivalvular involvement, identification of the pulmonary lesion is difficult because the clinical features are decided by the lesion of the more proximal valve. In isolated involvement, the murmur of pulmonary stenosis is easily recognized as an ejection systolic murmur often associated with a thrill most prominent over the left upper sterna border. Pulmonary regurgitation produces an early border, and this murmur may closely resemble that of aortic regurgitation. In many cases, the murmur increases during inspiration.

Treatment Plan

Management largely depends on the severity and etiology of pulmonary valve disease. Pulmonary valve replacement may have to be considered under the following indications
Management largely depends on the severity and etiology of pulmonary valve disease. Pulmonary valve replacement may have to be considered under the following indications | Source

Course And Prognosis

Course and prognosis

In quadrivalvular disease, the hemodynamic abnormalities are largely determined by the lesions of the proximal valves. Pulmonary valve disease may not alter the natural history significantly. However, recognition of pulmonary valve disease is important to decide the line of management. When pulmonary regurgitation is mild or moderate, right ventricle accommodates the increased diastolic blood volume without considerable hemodynamic disturbance. But severe pulmonary regurgitation may lead on to progressive right ventricular failure.

Treatment

Management largely depends on the severity and etiology of pulmonary valve disease. Pulmonary valve replacement may have to be considered under the following indications.

  1. Severe and progressive pulmonary regurgitation following surgical correction of tetralogy of Fallot or pulmonary stenosis;
  2. Tumours involving the pulmonary valve; and
  3. Infective endocarditis, when medical treatment fails.

Pulmonary Valve lesions if controlled and manged well are sure not a set of fatal clinical cases

© 2014 Funom Theophilus Makama

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