Causes of Pulmonary Stenosis

• Congenital (most common).
• Associated with Carcinoid syndrome, Noonan’s syndrome, Fallot’s tetralogy.
• May occur, if there is rubella in pregnancy.


• May be asymptomatic.
• Symptoms, such as fatigue, weakness and effort syncope may occur.


Precordium examination:

On palpation:
–– Left parasternal lift and epigastric pulsation (due to RVH).
–– Systolic thrill—Present in pulmonary area.
• On auscultation:
–– First heart sound—normal in all the areas.
–– Second heart sound—P2 is soft in pulmonary area and A2 is normal (wide splitting of the
second sound may be present).
–– Ejection systolic murmur (ESM) in pulmonary area, which radiates to the neck (more on
–– Fourth heart sound may be present (due to right atrial contraction).


• ECG—shows RVH and RAH.
• Chest X-ray—shows enlarged pulmonary conus, oligaemic lung fields, poststenotic dilatation
of pulmonary artery.
• Echocardiogram.

Types of Pulmonary Stenosis

There are three types of Pulmonary Stenosis(PS):
• Valvular.
• Subvalvular.
• Supravalvular.


• Right heart failure.
• Pulmonary embolism.


• In mild case, compatible with normal life (no specific treatment).
• In severe symptomatic case, when the pressure gradient is >50 mm Hg, balloon valvuloplasty
is the treatment of choice.
NB: Infective endocarditis is unusual in PS. Prophylactic antibiotic is unnecessary.