Indication of interventional procedure for isolated syncopal pulmonary stenosis in adolescents: Case reports and revue of literature.

Pulmonic stenosis refers to a dynamic or fixed anatomic obstruction to flow from the right ventricle to the pulmonary arterial vasculature. Although most commonly diagnosed and treated in the pediatric population, some patients with severe, isolated PS may be diagnosed for the first time as adults, and represents approximately 10% of all congenital heart disease. We report the cases of three adolescents, who presented to the ER after having several episodes of syncopes during exercise. The TTE showed a dome-shaped pulmonary valve, with a peak pulmonary velocity between 5,3 and 6,8 m/s, with a right ventricular hypertrophy and dilatation. We proceed to the balloon valvuloplasty and used balloon dilatation catheter until the waisting disappeared. An echocardiography was performed the day after the procedure, showing a drop peak pulmonary velocity and decreased right ventricular dilatation.

In older children and adults, percutaneous pulmonary valvuloplasty is the first line treatment for valvar pulmonary stenosis irrespective of symptoms. Catheter-based balloon valvotomy is recommended for patients with non-dysplastic valvular PS and with peripheral PS. Surgery is recommended for patients with sub-infundibular or infundibular PS and hypoplastic pulmonary annulus, with dysplastic pulmonary valves, and for patients with associated lesions which need a surgical approach, such as severe pulmonary regurgitation or severe tricuspide regurgitation.

Simple balloon dilatation can provide a definitive solution and avoid the need for surgery.