A management strategy for mild valvar pulmonary stenosis

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Pulmonary valve stenosis (PVS) is a frequent congenital heart defect, affecting approximately 1 in 1000 live births.
• Most PVS cases present with mild transvalvar gradients, necessitating evaluation of appropriate management strategies.

Purpose of the Study:

• To assess the long-term outcomes of mild PVS diagnosed in early childhood via echocardiography.
• To develop a management algorithm for mild PVS, identifying at-risk individuals while minimizing healthcare costs.

Main Methods:

• A single-center retrospective study included 146 patients diagnosed with PVS before age 10.
• Inclusion criteria: initial peak systolic Doppler gradient ≤40 mm Hg, no other congenital heart lesions, and ≥2 clinical evaluations.
• Data collected included initial and final peak systolic gradients (PSG) and follow-up duration.

Main Results:

• The median age at diagnosis was 3.9 months; average follow-up was 4.0 years.
• 73% of patients (107/146) showed very mild PVS (PSG ≤25 mm Hg) with no clinical change or murmur resolution.
• Only 3 patients (2%) progressed to PSG >40 mm Hg, with one requiring balloon valvuloplasty.

Conclusions:

• Mild PVS diagnosed in childhood is generally a benign condition, frequently resolving spontaneously.
• Infants with mild PVS require close observation during the first year.
• Established criteria suggest that ongoing cardiology follow-up may not be necessary for certain pediatric PVS patients.