Indications for pulmonary valve angioplasty in children

Pulmonary stenosis is a disease that makes it difficult for blood to flow from the right ventricle to the lungs. Pulmonary stenosis may be primary or with other congenital heart defects. Mild pulmonary valve stenosis may not require repair. However, for some children with moderate to severe condition may be indicated for pulmonary valve angioplasty.

Pulmonary stenosis is a birth defect of the heart. It can happen when the pulmonary valve does not develop as it should in a baby during the first 8 weeks of pregnancy. The pulmonary valve is the junction of the right ventricle that pumps blood to the pulmonary artery. Usually it has a three-blade valve that acts like a one-way gate. This structure only allows blood to flow from the right ventricle to the pulmonary artery and does not allow blood to flow back from the pulmonary artery to the right ventricle.
For pulmonary stenosis, the valve is open and blood is more difficult to flow than usual. The leaflets may be stuck together or they may be thick and unable to open fully. In some cases, the pulmonary valve can become narrowed. In some cases, the stenosis may not be related to a problem with the leaflets but with the area just below and above the valve.
Pulmonary valve stenosis varies with the amount of blood being blocked. A child with severe pulmonary stenosis is likely to be quite sick and have obvious symptoms. A child with mild pulmonary stenosis may have few or no symptoms. Babies may develop symptoms some time after birth. Gradually, congestion and cardiovascular symptoms will get worse over time. This condition is not common during pregnancy.
Pulmonary stenosis often occurs as part of other complex congenital heart defects.

Pulmonary stenosis occurs when the pulmonary valve does not develop as it should or the area below or above the valve does not fully develop in a baby during the first 8 weeks of pregnancy. Some congenital heart defects are passed down through families.

Some children with pulmonary stenosis have no symptoms. The more severe the stenosis, the more symptoms the child has. The most common symptoms of pulmonary stenosis may include:
Tachypnea Purple around the lips or fingers means low oxygen levels (cyanosis) Shortness of breath Feeling tired, especially with activity or exercise Tachycardia Tachycardia Swelling of the legs, insteps, face, or abdomen Fainting (fainting) Chest tightness Symptoms of pulmonary stenosis can be similar to those of other health conditions. When you have these symptoms, you should take your child to see a health care provider for a diagnosis.

The health care provider will ask about your child's symptoms and health history. He or she will send your child for a health check-up. Your doctor will listen to your heart and lungs with a stethoscope. The doctor may hear abnormal heart sounds (heart murmurs). Your doctor may also notice other signs or symptoms.
Symptoms of a heart murmur will help your doctor make a diagnosis. The child may also order tests such as:
Chest X-ray may show structural changes in the heart or pulmonary arteries. Electrocardiogram (ECG): An electrocardiogram helps to check the electrical activity of the heart. An ECG can detect heart rhythm abnormalities (arrhythmias). Although the electrocardiogram is usually unremarkable, the presence of abnormalities helps the doctor diagnose pulmonary valve stenosis. Echocardiogram: By using ultrasound waves to create moving pictures of the heart and heart valves. This test helps the doctor check the function of the heart and the valves in the diagnosis of pulmonary valve stenosis. Cardiac catheterization: The doctor will place a thin, flexible tube (catheter) into a blood vessel in the groin. The doctor will insert a catheter to your heart. The heart is then checked by measuring the blood pressure and oxygen levels in the heart chambers. The pulmonary artery and aorta will also be evaluated. Your doctor will use contrast dye to better see the structures inside your heart.

Mild pulmonary stenosis usually does not require treatment. Moderate or severe stenosis needs repair. Indications for pulmonary valve angioplasty in children include:
Newborns presenting with symptomatic pulmonary valve stenosis and large gradients. If the transvalvular pressure gradient is greater than 40 mm Hg with low cardiac output or if the ductus arteriosus is present with a right-left shunt. Children with moderate-severe pulmonary valve stenosis accompanied by symptoms. The pressure difference across the pulmonary valve is greater than 40 mmHg with normal cardiac output. The best time to have surgery is when the baby is 9 to 12 months old. Some babies will be very sick and need care in the intensive care unit (ICU) before the disability can be corrected. Some babies may need urgent repair if the stenosis is very severe. Prostaglandin, a medicine that keeps the ductus arteriosus open, will be given to get enough blood circulating in the lungs. Once the child is stable, a procedure will be performed to repair the valve. A child with less severe stenosis will be scheduled for repair.
Pulmonary valve dilatation with balloon dilation or dilatation of the heart valve. Your doctor will insert a cardiac catheter that is performed as in a diagnostic test. The catheter has a balloon on the tip. When the catheter reaches the valve or narrowed area, the doctor briefly inflates the balloon to stretch it out. Children with dilated bullae may need antibiotics to prevent heart infections after they leave the hospital.

If left untreated, moderate to severe pulmonary stenosis can cause complications. The right ventricle has to work harder to try to move blood through the pulmonary valve or narrowed area. Over time, the right ventricle becomes enlarged and is no longer able to handle extra tasks. It does not pump well (heart failure). Another possible complication is an irregular heart rhythm (arrhythmia).

The prognosis for children with pulmonary stenosis is usually very good. For a time, your child's cardiologist may recommend that your child take antibiotics to prevent infection of the heart lining and valves (bacterial endocarditis). Your child may need to take medicine before having medical and dental procedures.
In some cases, the child may have to repeat the procedure from time to time to make the valve open. Your child may need a pulmonary valve replacement as a teen or young adult to prevent complications.
Your baby will need regular follow-up care at a congenital heart center throughout life.
Pediatrics Department at Vinmec is one of the few multi-specialty hospitals with a full range of doctors specializing in neurology, cardiology, gastroenterology, nutrition, psychology, endocrinology, hepatology, helping to handle it quickly and in a timely manner. when diseases are discovered during the examination. As a key area of ​​Vinmec Medical system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of leading pediatricians: including leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All are well-trained, professional, with a mind - range, understanding young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.