Pulmonary Atresia and Pulmonary Stenosis

Miroslav Elek
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Pulmonary Atresia and Pulmonary Stenosis - Investigations
In physical exam in PA with VSD by auscultation we find heart murmur of PDA and collateral vessels, second heart tone is monocomponent. Heart is „clog“ shaped on X-ray with unequal pulmonary vascularization in different parts of lungs. ECG shows right ventricle hypertrophy and right axis deviation. In newborn with PA with IVS there is a heart murmur of tricuspid regurgitation and monocomponent first and second heart tone. On X-ray there is a slightly enlarged heart, and reduced pulmonary vascularisation. On ECG there is a left ventricle dominaion. Echocardiography is gold standard in diagnosis and evaluation of pulmonary atresia. Angiography can also be performed.
In pulmonary stenosis dominant clinical sign is heart murmur and weakened second pulmonary heart tone. ECG shows right ventricle hypertrophy and right axis deviation. On X-ray we can see poststenotic dilatation of pulmonary artery. Final diagnosis is confirmed by echocardiography. Echocardiographic exam is necessary for assessment of severity of stenosis based on pressure gradient, also for assessment of pulmonary valve morphology, right ventricle hypertrophy and associated heart defects. Heart cateterisation and angiography can be performed for re-measurement of pressure gradients and detecting peripheral pulmonary stenosis.


References
Pulmonary Atresia and Pulmonary Stenosis Pulmonary Atresia and Pulmonary Stenosis 05/14/2016
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