肺动脉瓣疾病

诊断

Some types of pulmonary valve stenosis are diagnosed at birth or soon after. But sometimes, pulmonary valve disease isn't noticed until later in life.

To diagnose pulmonary valve disease, a healthcare professional uses a stethoscope to listen to the heart. A whooshing sound, called a heart murmur, may be heard.

Tests

Tests are done to check the heart and confirm a diagnosis of pulmonary valve disease. Tests may include:

• Electrocardiogram (ECG or EKG). This quick and painless test shows how the heart is beating. Sticky patches with sensors on them, called electrodes, attach to the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which prints or displays the results.
• Echocardiogram. Sound waves create images of the heart. An echocardiogram shows blood flow through the heart and heart valves. It can show the shape of the pulmonary valve.
• Chest X-ray. A chest X-ray shows the heart and lungs. It can tell if the heart is larger than usual or if there is fluid around the lungs. Some types of heart valve disease can cause fluid buildup.
• Cardiac catheterization. This test isn't often used to diagnose heart valve disease. But it may be done to tell how severe pulmonary valve disease is. A long, thin flexible tube called a catheter is inserted in a blood vessel, usually in the groin or wrist. It's guided to the heart. Dye flows through the catheter into the arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.
• Other imaging tests. Magnetic resonance imaging (MRI) and computerized tomography (CT) scans are sometimes used to confirm pulmonary valve disease, such as stenosis.

Heart valve disease stages

After testing confirms a diagnosis of heart valve disease, your healthcare team may tell you the stage of disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.

Heart valve disease is staged into four basic groups:

• Stage A: At risk. Risk factors for heart valve disease are present.
• Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
• Stage C: Asymptomatic severe. There are no heart valve symptoms but the valve disease is severe.
• Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.

治疗

Pulmonary valve disease treatment depends on:

• The symptoms.
• The stage of the disease.
• If the disease is getting worse.

Treatment may include:

• Regular health checkups.
• Surgery to repair or replace the valve.

If symptoms are mild, the only treatment may be regular health checkups and imaging tests to see how the heart is working.

Surgeries or other procedures

Surgery or another treatment may be needed to fix or replace the pulmonary valve.

The decision to repair or replace a damaged pulmonary valve depends on many things, including:

• The stage of pulmonary valve disease.
• Symptoms.
• Age and overall health.
• Whether or not the condition is getting worse.
• Whether surgery is needed to correct another valve or heart condition.

Pulmonary valve surgery may be done at the same time as other heart valve surgeries. In general, surgeons recommend pulmonary valve repair when possible, as it saves the heart valve and improves heart function.

Types of surgery or procedures used to treat pulmonary valve disease include:

• Balloon valvuloplasty. This treatment is often used to treat infants and children with a narrowed pulmonary valve. During balloon valvuloplasty, a surgeon places a thin, hollow tube called a catheter into a blood vessel, usually in the groin, and guides it to the heart. A balloon on the tip of the catheter is inflated, which makes the valve opening wider. The balloon is deflated and removed.
• Pulmonary valve replacement surgery. If the pulmonary valve can't be fixed, a surgeon might replace the valve with a mechanical valve or one made from cow, pig or human heart tissue. A tissue valve also is called a biological tissue valve.
• Transcatheter pulmonary valve replacement. Sometimes, the pulmonary valve can be replaced with a minimally invasive procedure, which uses thin, flexible tubes and smaller surgical cuts. A transcatheter procedure also may be used to place a new pulmonary valve in a previously replaced valve that's now failing. This is called a valve-in-valve procedure.

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