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Absent pulmonary valve

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Absent pulmonary valve
Absent pulmonary valve

Alternative Names    Return to top

Absent pulmonary valve syndrome; Congenital absence of the pulmonary valve; Pulmonary valve agenesis

Definition    Return to top

Absent pulmonary valve is a rare defect in which the pulmonary valve that carries oxygen-poor blood from the heart to the lungs is either missing or poorly formed. This condition is present at birth (congenital).

See also: Tetralogy of Fallot

Causes    Return to top

Absent pulmonary valve occurs when the pulmonary valve doesn’t develop properly while the baby is in the mother’s womb. It often occurs as part of a rare condition called tetralogy of Fallot.

The pulmonary valve is either absent or poorly formed and the ring that holds the valve in place (annulus) is usually small. This leads to a blockage in the flow of blood across the valve, and valve leakage.

There is also usually a hole between the left and right ventricles of the heart (ventricular septal defect). One of the most important parts of this syndrome is very enlarged (dilated) branch pulmonary arteries, which press on the tubes that bring air to the lungs (bronchi).

Other heart defects that can occur with absent pulmonary valve include:

Heart problems that occur with absent pulmonary valve may be due to defects of the genes (chromosomes).

Symptoms    Return to top

When the pulmonary valve is missing, the branch pulmonary arteries are very enlarged and press down on the airways in the lung (bronchial tubes), causing breathing problems.

Symptoms can vary depending on which other defects the infant has, but may include:

Exams and Tests    Return to top

Absent pulmonary valve may be diagnosed before the baby is born with a test that uses sound waves to create an image of the heart (echocardiogram).

During an examination, the doctor may hear a murmur in the infant’s chest.

Tests for absent pulmonary valve include:

Treatment    Return to top

Infants who have breathing symptoms should have surgery as quickly as possible. Even infants without symptoms should have surgery within the first 3-6 months of life.

Depending on the type of heart defects the infant has, surgery may involve:

Types of surgery for absent pulmonary valve include:

Infants with severe breathing symptoms may need to get oxygen or be put on a breathing machine.

Outlook (Prognosis)    Return to top

Without surgery, most infants who have severe lung complications will die.

Surgery can treat the condition and relieve symptoms in many cases.

Possible Complications    Return to top

When to Contact a Medical Professional    Return to top

Call your health care provider if your infant has symptoms of absent pulmonary valve. If you have a family history of heart defects, talk to your doctor before or during pregnancy.

Prevention    Return to top

There is no way to prevent this condition; however, families can have genetic testing to determine their risk of certain related heart defects.

References    Return to top

Park, MK. Park: Pediatric Cardiology for Practitioners. 5th ed. Philadelphia, Pa: Mosby; 2008.

Nölke L, Azakie A, Anagnostopoulos PV, Alphonso N, Karl TR. The Lecompte maneuver for relief of airway compression in absent pulmonary valve syndrome. Ann Thorac Surg, 2006;81:1802-1807.

Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Surgical treatment of absent pulmonary valve syndrome associated with bronchial obstruction. Ann Thoracic Surg, 2006;82:2221-2226.

Update Date: 3/7/2008

Updated by: Mark A Fogel, MD, FACC, FAAP,Associate Professor of Pediatrics and Radiology, Director of Cardiac MR, The Children's Hospital of PhiladelphiaDivision of Cardiology, Philadelphia, PA.

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