Congenital heart disease: rational choice of treatment for pulmonary valve stenosis (V)

  1.Pulmonary valve stenosis that does not require treatment Some pulmonary valve stenosis with relatively mild stenosis, with transvalvular pressure difference measured by ultrasound below 30 mmHg and no obvious right ventricular hypertrophy, will not cause significant impact on the child and can be treated without treatment; those with transvalvular pressure difference between 30 and 40 mmHg can be followed up by outpatient cardiac ultrasound and electrocardiogram, and if in continues to worsen, with obvious right ventricular hypertrophy, and with symptoms such as chest tightness, chest pain, and exertional dyspnea, then treatment is required.  2.Interventional treatment For most simple pulmonary stenosis with a transvalvular pressure difference of 40 mmHg or more, transcatheter balloon dilation is the treatment of choice, especially for typical pulmonary stenosis, interventional treatment is very effective.  Interventional treatment is also effective in mild and moderate dysplastic pulmonary valve stenosis, with poor results in severe dysplasia. The price is lower than that of surgical procedures.  3.Surgical treatment is suitable for any type of pulmonary valve stenosis that needs to be treated. The disadvantage is that it is somewhat invasive and requires extracorporeal circulation.  4.Mosaic treatment Some newborns or small infants with very severe pulmonary stenosis, where peripheral vascular puncture for catheter intervention is risky and those who do not want to perform extracorporeal circulation, can use a small surgical incision to dilate the stenotic valve via right ventricular outflow tract puncture.  Patients with branch pulmonary stenosis, where restenosis may occur after surgery, may be considered for transcatheter placement of a vascular stent.