Pulmonary Valve Stenosis, Pediatric
Pulmonary valve stenosis is a heart problem some children are born with (congenital heart defect). This defect is a stiffening or narrowing (stenosis) of a one-way valve in the heart. It is the valve that allows blood to flow from the pumping chamber on the right side of the heart (right ventricle) into the blood vessel that carries blood to the lungs. If not enough blood is flowing through the valve, not enough oxygen will get into your child’s blood. The child’s heart will also be forced to work harder.
Pulmonary valve stenosis develops during the first 8 weeks as a child is growing inside the womb. It sometimes develops with other types of heart abnormalities. Pulmonary valve stenosis can range from
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• Bluish color of the skin.
• Trouble feeding.
• Not gaining weight.
• Swelling of the feet, ankles, face, or belly.
Older children may become short of breath when playing and may have chest pain.
DIAGNOSIS
This condition may be diagnosed based on:
• Your child's symptoms and a physical exam. During the exam, the health care provider will listen for an abnormal heart sound (heart murmur). This is caused by blood flow through the narrowed valve.
• Tests to confirm the diagnosis. Tests may include:
○ Chest X-ray. This may show an enlarged heart chamber caused by increased work.
○ Electrocardiogram (ECG). This is an electrical tracing of the heart’s rhythm. It may show abnormal heartbeats.
○ Echocardiogram. This test creates an image of the heart using sound waves and a computer. It may show an abnormal valve.
○ Cardiac catheterization. In severe cases, a health care provider may thread a long, thin, flexible tube (catheter) into the heart through a blood vessel in the groin. This catheter can measure pressure and oxygen levels on both sides of the pulmonary valve.
TREATMENT
Treatment for pulmonary valve stenosis depends on how severe the condition
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This is the most common treatment. In this procedure, a catheter is placed in the heart. The catheter is placed through the valve. Then a tiny balloon on the end of the catheter is blown up to open the valve.
○ Heart surgery to open, repair, or replace the valve.
HOME CARE INSTRUCTIONS
Follow all instructions from your child's health care provider.
• Give your child over-the-counter and prescription medicines only as told by his/her health care provider.
• Do not give your child aspirin unless instructed to do so by your child's health care provider or cardiologist.
• Ask the health care provider whether your child has any activity restrictions. Depending on the severity of the the condition, some children can participate in the usual activities.
• Your child does not have to follow a special diet.
• Make sure your child’s immunizations are current.
• Let all health care providers know that your child has pulmonary valve stenosis before any medical procedure.
• Ask your health care provider if your child should take antibiotic medicine before having any medical or dental procedure.
• Keep all follow-up visits as told by your health care provider. This is
Pharmacological therapy would include; prostaglandin E1 or E2 to maintain the patency of the ductus arteriosus, diuretics, dobutamine to increase contractility of the volume loaded right ventricle. (The Lancet)
Cardiac Echogram- This is to identify structural abnormalities in cardiac function, cardiac output, abnormal valves and MI (Buttaro, Trybulski, Polgar-Bailey, & Sandburg-Cook, 2017).
A heart murmur are harmless, healthy and don’t need a treatment. During a physical exam, doctors know that every child has a heart murmur and can hear the whooshing sound. There are some things that can be abnormal when it can be very damaged by the heart valve which 1/3 of the populations are born with valve problems. This condition is making the heart go faster than it normally would and it can be forced to have the blood goes faster. The causes are anemia, high blood pressure, thyroid, and a fever. Those causes can make the blood flow a lot faster, which can be dangerous if the problems are by the birth defect of the child. The valves open and close by four chambers, two on top and two on bottom. Stenosis, mitral prolapse, congenital, and
Congenital heart defects (CHD) are birth defects that are considered the common in the United States. These defects affect a newborn child’s blood flow to and from the heart and sometimes can leave the heart lacking parts that make it necessary for the heart to do its job. According to the Centers for Disease Control and Prevention (CDC) (2014), 1 in 4 children born with a CHD is considered critical and will result in that child needing heart surgery or other similar procedures within the first years of its life. These CHD’s can range from Atrial Septal Defects, Coarctation of the aorta, Ebstien anomaly, Pulmanary artesia, Tetralogy of Fallot, Trancus Arteriosus, Hypoplastic Left Heart Syndrome, as well as many others (Centers for Disease Control and Prevention, 2014). The specific CHD that will be covered in detail will be the Hypoplastic Left Heart Syndrome (HLHS). HLHS accounts for nearly 960 congenital birth defects per year and
A congenital heart defect is an issue with the actual anatomy of the heart. This issue is normally presented at the time of birth. Congenital heart defects are some of the most common type of birth defect. Eight out of one thousand newborns are diagnosed with a congenital heart defect. Congenital defects can often affect any anatomical part of the heart. It can affect the valves, walls, arteries and veins near the heart. Congenital defects can affect the flow of blood through the heart, they can cause it to go the wrong direction, be blocked or slowed down. “Although aortic coarctation can occur anywhere along the aorta, the coarctation is most often located near a blood vessel called the ductus arteriosus”. (2)
Keep all follow-up visits as told by your child's health care provider. This is important.
After birth, a physical examination is conducted on the infant and with the help of a stethoscope, cardiac murmurs (i.e. extra or unusual sounds) can be heard, which indicate an underlying pathology. In order to determine the nature of the pathology, imaging studies such as a chest X-ray, cardiac MRI and echocardiograms may be done. Electrocardiograms are also of diagnostic value.
Heart murmurs are swishing or whooshing sounds created by turbulent blood with each heartbeat. This sound is usually observed through auscultation of the heart with a stethoscope. Many times, this sound is indicative to underlying cardiac abnormalities. However, the sound can be benign and many live without incident and asymptomatic. Abnormalities to the structure of the heart may be the main cause. These malfunctions can be congenital in nature or may come with stress on the heart and valves. Common structural conditions are stenosis of the heart (mitral, aortic, tricuspid, pulmonary), regurgitations (mitral, aortic, tricuspid), septal defects and patent ductus arteriosus. Damage to the structure may also be caused by myocardial infarction,
Discuss your child’s condition with anyone who cares for your child, including teachers and coaches. Make sure they know what steps to take and that they have your child’s medicine available, if indicated.
The intra-cardiac technique is the most common and is carried out while the patient is under cardiopulmonary bypass and is an open-heart surgery. This is the procedure of choice for the majority of children and performed by most pediatric surgery centers. The trans-catheter approach is normally more complex and should only be considered in selected patients at pediatric centers that have expertise in this procedure.
Total anomalous pulmonary venous connection is a one of rare congenital heart defect. Its accounts 1% of total prevalence of heart defect abnormality. The estimated number of the cases is about one out of 10,000 live (1).The consequence of disrupting the normal development of venous drainage during gestational period leads to this malformation. That will lead to drainage of the pulmonary veins into the right atrium or branches of veins returning to the heart instead of drainage into the left atrium. A surgical repair of this anomalous considers the optimal treatment because it has shown a great decrease in death rate throughout the first year of life (2). Surgical intervention aims to establish a communication between the left atrium and the
When communicating with a child’s healthcare provider it is important that provider listen and show interest in the problems mentioned even if the provider feels it is nothing to worry about. As a parent of two children we have had many different pediatricians some who listened and cared about what we had concerns about and some who would just say I wouldn’t worry about it and not explain why. It is important for anyone who is caring for the child’s health and well-being to show interest in what the parents want to know or have worries about. Having professional that show they want to help with anything that is a worry helps parent be more open to telling the healthcare
The pulmonary valve is found to the right side of the heart. It is located between the pulmonary artery and the right ventricle. The pulmonary valve functions by moving blood from the heart to the arteries. Blood can only flow one way through this valve. Heart rate affects how frequently this happens.
To discover the risk for VHD, a health care team will use echocardiography as the main source of testing. Echocardiography (EKG) uses sound waves to create a moving picture of a patient's heart as it beats. This invasive medical procedure can reveal the size and shape of the heart valves and chambers, blood pumping efficiency, and whether a valve is narrow or has backflow. Patients may require a transesophageal echo to develop an enhanced image of the heart.
“Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterizations. Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of cardiac catheterization procedure.” (Mayo Clinic Staff, 2016). In a coronary angiogram, a dye that is detectable by X-ray is introduced into the blood vessels of the heart. The X-ray machine quickly takes a sequence of images showing the flow of the blood vessels.