Adult

In this condition the valve between the right sided pumping chamber of the heart and the lung arteries (pulmonary valve) is narrowed.

The muscle of the right sided pumping chamber (right ventricle) has to work harder than normal and the muscle can become thickened. In most cases it is not a serious problem and needs no treatment, but if the narrowing is very severe the heart cannot pump normally and this may require treatment.

Treatment

Balloon Valvuloplasty

If the valve is severely narrowed, treatment may be needed, usually keyhole treatment rather than open heart surgery. Most cases can be treated by stretching the narrow valve open with a balloon (called “balloon valvuloplasty”). This is done under general anaesthetic and involves passing a long tube with a collapsed balloon on the end of it (a balloon catheter) into the vein at the top of the leg and feeding it into the heart across the narrow valve. Using X-ray pictures, the balloon is positioned in the narrow valve and is blown up, stretching the valve open. This is usually a very effective form of treatment and is very low risk – the chance of death during the procedure is less than 1 in 100. Usually only one night’s stay in hospital is necessary. Sometimes if the narrowing is only partly relieved by the balloon it is worth repeating the procedure at a later date.
Because the thickened heart muscle (due to the narrow valve) itself can cause some narrowing, it is not always possible to tell straight after the procedure exactly how successful it has been – sometimes we have to wait for a few weeks for the thickened heart muscle to return to normal. In a small proportion of patients, the thickened heart muscle doesn’t return to normal and if this causes significant narrowing inside then heart surgery is needed to remove some of the muscle.

If you choose to have a balloon valvuloplasty you will be placed on the waiting list.

You will receive a letter through the post with your procedure date. We try to give you around 4 weeks’ notice but it’s often not possible for us to give you more than a week or two notice of the date of your procedure. Please contact the secretary as soon as you receive your letter to confirm on 0113 3928184 or leedsth-tr.paedcardcathlist@nhs.net .

This is very important, if you do not confirm in good time your slot will be offered to someone else.

Most people who are attending for a pulmonary balloon valvuloplasty do not need to attend a pre-assessment clinic. If you have a lot of other health problems then we may require you to attend pre-assessment or we may arrange some routine blood tests at your GP practice.

If you are taking an anticoagulant drug (blood thinner) this should be stopped in advance (usually around 3 days). A nurse will contact you to advise upon this around a week in advance of the procedure.

If you receive the date for your procedure and become unwell, or something has changed since your clinic appointment, please contact the specialist nursing team who will advise whether any further tests are necessary.

We appreciate it can be quite a wait between your clinic appointment and your procedure so, if in the time waiting for your procedure you have any questions or concerns, then please contact the specialist nursing team who will be happy to assist you.

Surgical treatment
Sometimes the pulmonary valve cannot be stretched open using a balloon and open heart surgery will be needed. This involves opening the chest (usually in the middle at the front) and the function of the heart and lungs being taken over by a machine so the surgeon can open the heart and cut the narrow valve open. There is a very small risk of death (less than 1 in 100) and a very small risk of major complications such as brain damage (less than 1 in 100). Other complications such as fluid collecting around the heart or lungs can occur after the operation but these are very rarely serious. After the operation you would need to stay in hospital for about 5-7 days, although a longer stay might be necessary if there are any complications.

A video explanation of pulmonary incompetence (or pulmonary regurgitation) and its treatment by pulmonary valve replacement.

The long term future
If you have not needed any treatment by the time you become an adult you are unlikely to need treatment, but in rare cases the valve can become narrower in later adult life. It is therefore important to attend a specialist cardiology clinic, to monitor your heart from time to time. Patients who have a good result from balloon stretching of the valve or surgery usually do not need any further treatment. However, after any kind of treatment for pulmonary stenosis, the pulmonary valve never works completely normally, and will leak to some extent (some of the blood pumped out of the heart to the lungs flows back into the heart through the valve). If you have a leak on the valve there is a chance that you may need surgery to replace or repair the valve in later life.

Lifestyle issues
You should not be restricted by your heart condition, and we would encourage you to follow an active lifestyle to maintain your health.

If you are thinking about starting a family, talk to your cardiologist prior to getting pregnant. We may want to some more tests to assess your heart function.

Good dental hygiene is important, to prevent endocarditis (an infection within the heart). It is important to visit the dentist regularly, but you no longer require antibiotics prior to dental work. Due to the increased risk of infection we would also advise against body piercing and tattoos.