Pulmonary Valvular Stenosis
Echocardiography indicating 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.
Measurement of the left to right PDA. The CW-doppler indicates that the profile is left to right and with a peak gradient in systole of 30 mmHg. Knowing that the systolic blood pressure of the newborn was 60 mmHg, one can assume that the systolic pulmonary arterial pressure is about 30 mmHg. The gradient through the valve was 90 mmHg, indicated that the RV peak systolic pressure was around 120 mmHg. The RV is suprasystemic.
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.
The CW-Doppler indicates a gradient through the valve of 82-92 mmHg. This indicates a significant obstruction.
Visualization of the valve in 2D still frame, with measurements below of the opening (orifice). The measurement is often difficult to make in newborns due to non-homogeneous opening of the valve. The orifice is not circular but irregular in shape.