Pulmonary Valvular Stenosis

Pulmonary valve is seen in parasternal long axis view. While it is opening, there is doming of the pulmonary valve, which has thick leaflets. 

The ductus arteriosus (tortuous) is seen here and left to right.

Still image with the pulmonary valve closed in parasternal long axis view. The valve is thick and leaflet tips are abnormal.

The left and right pulmonary arteries are of normal caliber. The ductal flow during fetal life allows for appropriate growth of the pulmonary vessels. 

Some flow passing through the pulmonary valve with acceleration via Colour Doppler. The colour box must show flow through the pulmonary valve. In pulmonary atresia, there is no flow through the valve via colour doppler, but flow is seen retrograde from the ductus arteriosus. 

Apical view showing the RV outflow tract and the colour flow box indicating that flow is originating below the valve and goes through the stenotic valve with acceleration. 

The apical 4 chamber view indicates that there is good function of the right ventricle. There is some hypertrophy of the RV. However, one may miss the presence of RVOT obstruction without the appropriate sweep towards the RVOT and with Colour Doppler.  The RV is non-apex forming but tripartite. There is a hypertrabeculated left ventricle, possibly from the increased volume of flow towards the LV during fetal life.