MEDizzy - You are seeing a 21-year-old woman for the first time today

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Disorders of the cardiovascular system 2

You are seeing a 21-year-old woman for the first time today in the primary care clinic. She has never seen a physician before because her parents did not believe in Western medicine. On history, she states that she feels tired occasionally and feels like she could not quite keep up with her peers in college physical education classes. On examination, you note a systolic murmur in the left second interspace preceded by a presystolic click. A transthoracic echocardiogram confirms the presence of pulmonic stenosis with a peak gradient of 60 mmHg and doming of the pulmonic valve without any pulmonic regurgitation. What is her best treatment option?

ExplanationPulmonic stenosis is a rare valvular lesion encountered in adults. Fortunately, percutaneous balloon valvotomy often provides a highly efficacious, relatively low-risk therapeutic option. Diuretics can be used to treat symptoms and signs of right heart failure. Provided there is less than moderate pulmonic regurgitation, pulmonic balloon valvotomy is recommended for symptomatic patients with a domed valve and a peak gradient >50 mmHg (or mean gradient >30 mmHg) and for asymptomatic patients with a peak gradient >60 mmHg (or mean gradient >40 mmHg). Surgery may be required when the valve is dysplastic (as seen in patients with Noonan syndrome and other disorders).