Pediatric Heart Expert Forum
2yr old with pulmonary stenosis
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2yr old with pulmonary stenosis

my 2yr old daughter has pulmonary stenosis, at her last check up we were told the thickness of the lining of the pulmonary valve was 40 gradient, what are the chances of her needing surgery as this is something that plays on my mind over and over
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Dear bombom06:  Pulmonary valve stenosis is a common congenital heart valve abnormality.  Most patients are completely asymptomatic but have a heart murmur.  The cardiologist will do an electrocardiogram (EKG) to look for increased forces from the right side of the heart (called right ventricular hypertrophy) and an echocardiogram which allows them to make an estimate of how much blockage exists across the valve.  Usually mild pulmonary valve stenosis is a pressure gradient under 40 mmhg.  Moderate stenosis is an echo gradient of 40 to 60 mmhg, and severe stenosis is usually a pressure gradient across the valve of greater than 65 to 70 mmhg.  When the blockage is confined to the level of the valve (meaning that there is no blockage below or above the valve), then a cardiac catheterization and balloon dilation of the valve can be done in the severe cases.  Usually no intervention is required in an asymptomatic patient with mild to moderate pulmonary stenosis. Open heart surgery is usually reserved for more complex conditions, or when severe valve stenosis does not respond to balloon dilation.  From your description, it sounds like your daughter is not close to needing an intervention.  For the moment just stick with the routine follow up as planned with your cardiologist.
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The Children’s Hospital of Philadelphia
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