Severe Congenital Pulmonic Stenosis without Marked Right Ventricular Hypertension

Abstract

Obligatory relations exist between orifice size, flow, and pressure gradient across a stenotic pulmonary valve. If the cardiac output is reduced, the patient may have severe stenosis and present only moderate right ventricular hypertension. This situation may be an acute one, which will produce progressive symptomatology, or a chronic one, which, in the growing child, will produce poor physical growth. Catheterization should be done if any of the following is present: severe symptoms, severe right ventricular hypertrophy electrocardiographically, or evidence of reduced cardiac output (such as otherwise unexplainable poor physical growth). Operation is urgently indicated if catheterization reveals either right ventricular systolic hypertension greater than 90 to 100 mm. of mercury or if there is evidence of a very small pulmonary orifice.