Complications
Early complication of valvuloplasty; may require surgical intervention.
Early complication of valvuloplasty; may require surgical intervention.
Early complication of valvuloplasty; management will depend on type and severity.
Dynamic stenosis due to continued vigorous contraction of the RV previously needed to overcome the PS.
Recognised immediately post-procedure due to persistent obstruction to pulmonary outflow.
May require medical therapy with a beta-blocker or continuation of alprostadil for a short period of time post-intervention, usually less than 2 weeks.
Invariably, relief of the valvular stenosis results in incompetency of the pulmonary valve. This is due to stretching of the annulus and failure of the leaflets to coapt. The resulting regurgitation can be mild, moderate, or severe and requires ongoing evaluation by a cardiologist, with the frequency of evaluation dependent on the severity of the regurgitation.
In general, pulmonary insufficiency is well tolerated over a long time period.
In severe PS, the right ventricle (RV) will eventually fail as the myocardium becomes unable to support the enhanced work load imposed by the PS.
Patients present with symptoms of exercise intolerance, increasing dyspnoea, jugular venous distension, peripheral oedema, pleural effusion, ascites, and hepatomegaly. These signs and symptoms indicate that the condition has progressed to critical PS and warrant immediate referral to a (paediatric) cardiologist.
Although initial management with digoxin and loop diuretics will be directed at the heart failure, urgent PS treatment (percutaneous balloon valvuloplasty or surgery) is required for definitive therapy and to prevent permanent damage to the RV.
Occurs due to limited pulmonary blood flow with either profound cyanosis or low cardiac output and right heart failure.
Major complication requiring surgical intervention, occurring in around 0.1%.[22]
Major complication requiring surgical intervention, occurring in around 0.2%.[22]
Major complication, occurring in around 0.2%.[22]
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