A transpulmonary valve gradient <30 mmHg indicates mild PS, 30-50 mmHg is moderate PS, and >50 mmHg is considered severe PS. Mild to moderate PS rarely causes symptoms, and progression tends not to occur. Pts with higher gradients may manifest dyspnea, fatigue, light-headedness, chest pain (RV ischemia).
Jugular venous distention with prominent a wave, RV parasternal impulse, wide splitting of S2 with soft P2, ejection click followed by “diamond-shaped” systolic murmur at upper left sternal border, right-sided S4.
Normal in mild PS; RA and RV enlargement in advanced PS.
Often shows poststenotic dilatation of the pulmonary artery and RV enlargement.
| TREATMENT | ||
Pulmonic StenosisSymptomatic or severe stenosis requires balloon valvuloplasty or surgical correction. |
Congenitally Bicuspid Aortic Valve 
One of the most common congenital heart malformations (up to 1.4% of the population); rarely results in childhood aortic stenosis (AS), but is a cause of AS and/or regurgitation later in life. May go undetected in early life or suspected by the presence of a systolic ejection click; often identified during echocardiography that was obtained for another reason. See Chap. 116 Valvular Heart Disease for typical history, physical findings, and treatment of subsequent clinical aortic valve disease.
Aortic constriction just distal to the origin of the left subclavian artery is a surgically correctable form of hypertension (Chap. 119 Hypertension). Usually asymptomatic, but may cause headache, fatigue, or claudication of lower extremities. Often accompanied by bicuspid aortic valve.
Hypertension in upper extremities; delayed femoral pulses with decreased pressure in lower extremities. Pulsatile collateral arteries may be palpated in the intercostal spaces. Systolic murmur is best heard over the upper back at the left interscapular space. Continuous murmur over the scapula may also be present due to collateral blood flow.
Can delineate site and length of coarctation, and Doppler determines the pressure gradient across it. MR or CT angiography also visualizes the site of coarctation and can identify associated collateral vessel formation.
| TREATMENT | ||
Coarctation of the AortaSurgical correction (or percutaneous transcatheter stent dilation in selected pts), although hypertension may persist. Recurrent coarctation after surgical repair may be amenable to percutaneous balloon dilatation. |