Pulmonary valve area can hear ejection sound

Introduction It refers to the stenosis at the outlet of the pulmonary artery, causing obstruction of right ventricle, including pulmonary stenosis, right ventricular stenosis and pulmonary valve, pulmonary trunk and branch stenosis. This disease is more common in congenital heart disease, and the incidence rate of male and female is similar. Severe stenosis, poor development. The anterior region of the heart is bulged, and the heart sounds are enlarged. The second rib of the left sternum has a grade 4-5 rough systolic murmur. Kneeling to the left, under the collarbone and at the back of the left shoulder. The narrow murmur of the funnel is the loudest, the part is low, the miscellaneous sound is related to the degree of stenosis, accompanied by fine tremor during systole. The second sound of the pulmonary valve is weakened or disappeared. In patients with mild to moderate stenosis, systolic jet sounds can be heard in the pulmonary valve area.

Cause

First, valvular pulmonary stenosis

Most commonly seen, the three leaflets merge into a cone-shaped shape, leaving a small hole of 2-4 mm in the center. In some cases, there are only two leaves, and the pulmonary trunk is dilated and expanded.

Second, right ventricular funnel stenosis

The muscles of the whole funnel are thickened to form long and narrow passages, which can also be muscle diaphragm type, which is annular and narrow, resulting in a third ventricle. If there is a valvular stenosis, it is called a mixed stenosis.

Third, pulmonary stenosis

It may involve part or all of the trunk of the common pulmonary artery, and may also extend to the left and right branches, often with a stenosis extending before and after.

Pulmonary artery outlet stenosis, right ventricle obstruction, right ventricular systolic load increased, right ventricular pressure increased, pulmonary artery pressure normal or reduced, systolic pressure gradient before and after stenosis, long-term ventricular hypertrophy, and right heart failure .

an examination

Related inspection

Doppler echocardiography

First, the symptoms

Mild stenosis, generally asymptomatic, moderate or above stenosis, may have fatigue, fatigue, palpitations and fainting. Late heart failure can occur.

If accompanied by an atrial septal defect or a patent foramen ovale, a right-to-left shunt, also known as Fallot's triad, has a purpura-like toe.

Second, physical signs

Severe stenosis, poor development. The anterior region of the heart is bulged, and the heart sounds are enlarged. The second rib of the left sternum has a grade 4-5 rough systolic murmur. Kneeling to the left, under the collarbone and at the back of the left shoulder. The narrow murmur of the funnel is the loudest, the part is low, the miscellaneous sound is related to the degree of stenosis, accompanied by fine tremor during systole. The second sound of the pulmonary valve is weakened or disappeared. In patients with mild to moderate stenosis, systolic jet sounds can be heard in the pulmonary valve area.

First, X-ray

No abnormal findings were found in light cases. In patients with moderate or severe stenosis, pulmonary vascular shadows are rare, lung fields are clear, with right ventricle and right atrium. The valvular stenosis has a pulmonary trunk bulge, the stenosis of the funnel and the mixed stenosis have a depression of the pulmonary artery.

Second, the ECG

ECG changes were associated with right ventricular pressure, moderate to severe stenosis, incomplete right bundle branch block, right ventricular hypertrophy and strain, and some cases had right atrial hypertrophy.

Third, echocardiography

The right ventricle and right atrium are enlarged. Can understand the nature, location and extent of pulmonary stenosis. Doppler ultrasound can detect systolic turbulence spectrum in the pulmonary artery.

Fourth, cardiac catheterization

The right ventricular pressure is increased, and there is a systolic pressure step between the right ventricle and the pulmonary artery. Under normal conditions, the pressure gradient should be less than 1.33 kPa (10 mmHg). The mild stenosis pressure step increased but was less than 5.33kpa (40mmHg), the pressure step was 5.33~13.3kpa (40-100mmHg) in moderate stenosis, and the pressure step was more than 13.3kpa (100mmHg) in severe stenosis. The pressure curve is continuously recorded from the pulmonary artery to the right ventricle to determine the type of stenosis.

Five, cardiovascular angiography

It is found that the extension of the right ventricle and pulmonary artery is extended, which can show the shape, extent and extent of the right ventricle, pulmonary valve, pulmonary artery and its branch stenosis, which is helpful to determine the surgical plan.

Differential diagnosis

Diagnosis can be made based on signs, X-rays, and electrocardiogram. Cardiac catheterization and right heart angiography can further reveal pathological anatomical changes in the right ventricle, pulmonary valve, and pulmonary artery. Need to pay attention to the identification of the following diseases.

First, atrial septal defect

See the atrial septal defect section.

Second, ventricular septal defect

See the ventricular septal defect section.

Third, primary pulmonary artery expansion

Similar to the mild pulmonary stenosis, but the primary pulmonary artery dilatation murmur is soft and no tremor, the second sound of the pulmonary valve is normal, and the cardiac catheter has no pressure gradient between the right ventricle and the pulmonary artery, and there is no shunt.

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