Changes

== Diagnosis ==

== Diagnosis ==

History and clinical signs can be indicative of heart disease. Upon physical examination, it is likely that a systolic ejection murmur over pulmonary artery in the left heart base will be heard. There will usually be normal femoral pulses. There may be signs of right sided congestive heart failure, such as ascites and jugular distension and jugular pulses.  

History and clinical signs can be indicative of heart disease. Upon physical examination, it is likely that a systolic crescendo-decrescendo ejection murmur over pulmonary artery in the left heart base will be heard. There will usually be normal femoral pulses. There may be signs of right sided congestive heart failure, such as ascites and jugular distension and jugular pulses.  

'''Radiographic''' findings may include right ventricular enlargement (DV view seen at 1 o'clock), right atrial enlargement and pulmonary artery enlargement (DV view seen at 2 o'clock). Changes are seen most clearly on the dorsoventral view.  

'''Radiographic''' findings may include right ventricular enlargement (DV view seen at 1 o'clock), right atrial enlargement and pulmonary artery enlargement (DV view seen at 2 o'clock). Changes are seen most clearly on the dorsoventral view.  

'''Echocardiographic''' findings may include right ventricular hypertrophy, poststenotic dilation of the pulmonary artery and abnormal pulmonic valve if the stenotic area is valvular. Doppler can be used to measure the pressure in the stenotic area and visualize abnormal flow.

'''Echocardiographic''' findings may include right ventricular hypertrophy, poststenotic dilation of the pulmonary artery and abnormal pulmonic valve if the stenotic area is valvular. Doppler can be used to measure the pressure in the stenotic area and visualize abnormal flow.

'''Electrocardiographic '''(ECG) signs include right ventricular hypertrophy (deep S waves, right axis deviation).  

'''Electrocardiographic '''(ECG) signs include right ventricular hypertrophy (tall P waves, deep S waves, deep Q waves, right axis deviation).  

Angiography may also be used to identify the defect.

Angiography may also be used to identify the defect.

== Treatment ==

== Treatment ==

In mild to moderate cases, if there are no clinical signs then no treatment is needed. In severe cases an invasive procedure may need to be performed. Possible options for surgery include a '''balloon valvuloplasty''' (done if pulmonic leaflets are fused) or '''surgical repair''' (done when more complex lesions and obstructions are present): '''valvulotomy, pericardial patch graft'''.

 

In mild to moderate cases, if there are no clinical signs then '''no treatment is needed'''.  

 

In severe cases, if the pressure gradient is greater than 100mmHg, an invasive procedure may need to be performed. Possible options for surgery include a '''balloon valvuloplasty''' (done if pulmonic leaflets are fused) or '''surgical repair''' (done when more complex lesions and obstructions are present): '''valvulotomy, pericardial patch graft'''.

 

If signs of right-sided heart failure are present, these should be managed medically with diuretics and vasodilators.

== Prognosis ==

== Prognosis ==

Mild to moderate cases have a good prognosis. Severe cases have a guarded prognosis.

Mild to moderate cases have a good prognosis. Severe cases have a guarded prognosis.

== References ==

== References ==