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Pulmonary stenosis during infancy, at teenage has right chamber enlarged with leakage. Advised waiting for surgery. Opinion?

My daughter was born with pulmonary stenosis at 6 months old she had the valve stretched with the ballon procedure. She is now 19 years old and her right chamber is one and a half enlarged and she has at least 30 percent leakage, but her doctor recommends waiting for surgery. I am scare what do you recommend? Do we need a second opinion?
Asked On : Tue, 6 Nov 2012
Answers:  1 Views:  42
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General & Family Physician 's  Response
Hello. I'm sorry your daughter has problems with her heart. It sounds like her doctor is keeping her long-term outlook in mind; delaying surgery until it is clearly indicated is in your daughter's best interest. As you know, every procedure to open your daughter's valve carries some risk, and each surgery becomes technically more difficult for the surgeon and more risky for the patient.
One of the criteria for performing surgery in patients with pulmonic stenosis is the peak systolic transvalvular gradient, which is a measure of the pressure difference across the valve when the heart contracts. If this gradient is quite high (>50), surgery is usually indicated. Transvalvular gradients can be estimated with an echocardiogram, which is a test I suspect your daughter has had recently. Reviewing her latest echo with the cardiologist might help ease your fears.
It might also reassure you to know that leaky pulmonic valves are usually well-tolerated, because the right side of the heart is subjected to much lower pressures than the left side. In most cases, pulmonic regurgitation ("back-leakage") can be treated medically, rather than surgically.
As always, though, if you're uncomfortable with the recommendations of your daughter's current physician, it's appropriate to seek a second opinion.
I hope that helps. My best to you and your daughter.
Answered: Tue, 6 Nov 2012
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