[The chest X-ray in children with pulmonic stenosis and intact ventricular septum (author's transl)]

Of 89 children with angiographically-documented pulmonic stenosis and intact ventricular septum (PST), 76 (85.4%) had valvular, 11 (12.4%) infundibular and 2 (2%) had supravalvular lesions. Standard, p. a. view, chest X-rays of children with a mean age of 6 7/12 years were evaluated with respect to 1. cardiac enlargement; 2. prominence of the pulmonic trunk; 3. diminished pulmonary vascular markings. The patients were divided into 3 groups according to the gradient measured across the pulmonic valve: Group 1: systolic pressure gradient less than 30 mm Hg (mild PST), 28 children; group 2: systolic pressure gradient between 30 and 80 mm Hg (moderate PST), 37 children; group 3: systolic pressure gradient greater than 80 mm Hg (severe PST), 24 children. Cardiac enlargement was found in a total of 56.2% of the children with no statistical difference in the severity of the lesion. A markedly ectatic pulmonary segment was observed in 12.5% of the children in group 3 but only in 2.7% of those in groups 1 and 2 respectively. Diminished pulmonary vascular markings were observed in a total of 9% with a distribution including no patient in group 1, 10.8% in group 2 and 16.6% in group 3. On combining all three of the radiologic criteria, 9% demonstrated completely normal findings of the heart and lungs, 5.6% showed cardiac enlargement with marked prominence of the pulmonic trunk and diminished pulmonary vascular markings. In the remaining patients, no statistically significant relationship between the constellation of findings and the severity of the stenosis was found. Thus, the results show that, in the individual case, the diagnosis of pulmonic stenosis with intact ventricular septum cannot be established from the standard chest X-ray.