Patients with mild PS do not require therapy but need to be monitored in an outpatient setting for progression of disease. While mild PS is thought of as a static lesion, studies using colour echocardiography suggest that infancy is the highest risk period for progression.[12]Rowland DG, Hammill WW, Allen HD, et al. Natural course of isolated pulmonary valve stenosis in infants and children utilizing Doppler echocardiography. Am J Cardiol. 1997 Feb 1;79(3):344-9.
http://www.ncbi.nlm.nih.gov/pubmed/9036756?tool=bestpractice.com
Therefore, patients need to be monitored annually until 4 years of age, after which clinical visits can range from every 3 to 5 years into adulthood. Less frequent follow-up may be appropriate for adult patients.[14]Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e35-71.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923
http://www.ncbi.nlm.nih.gov/pubmed/33332149?tool=bestpractice.com
Given the potential neurodevelopmental impacts associated with PS, incorporating comprehensive genetic evaluation and neurodevelopmental surveillance into the routine monitoring protocol is crucial, especially for patients who have undergone cardiac surgery or present with risk factors for developmental delays. This ensures a comprehensive approach to care that addresses all aspects of the patient's well-being.[7]Sood E, Newburger JW, Anixt JS, et al. Neurodevelopmental outcomes for individuals with congenital heart disease: updates in neuroprotection, risk-stratification, evaluation, and management: a scientific statement from the American Heart Association. Circulation. 2024 Mar 26;149(13):e997-1022.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001211
http://www.ncbi.nlm.nih.gov/pubmed/38385268?tool=bestpractice.com
Clinical visits should consist of history, physical examination, ECG, echocardiography, and an exercise test when indicated.[13]Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Aug 10 [Epub ahead of print].
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
http://www.ncbi.nlm.nih.gov/pubmed/30121239?tool=bestpractice.com
For those who have undergone an interventional procedure, follow-up will depend on the severity of stenosis after dilation. In general, there will be visits at 6 to 12 months, 5 years, and then every 10 years post-intervention.