What is Pulmonary Valve? Insufficiency, Stenosis and Surgery

Pulmonary valve surgery is performed to repair or replace a dysfunctional valve between the right ventricle and pulmonary artery. It ensures proper blood flow from the heart to the lungs.

Indications for pulmonary valve surgery include congenital defects, valve stenosis, and regurgitation. These conditions can impair cardiopulmonary function if untreated.

Surgical techniques involve valve repair, mechanical or biological valve replacement, depending on patient age and condition. Minimally invasive methods are increasingly preferred.

Postoperative care after pulmonary valve surgery includes anticoagulation therapy, infection prevention, and regular follow-ups. These measures support long-term recovery and valve function.

Definition	Surgical or interventional treatment of pulmonary valve dysfunctions such as stenosis or insufficiency.
Indications	Severe pulmonary valve insufficiency or stenosis, right ventricular dysfunction, exercise intolerance, arrhythmia, residual lesions after tetralogy of Fallot
Surgical Methods	Open surgery (mechanical or bioprosthetic valve replacement), minimally invasive surgery (valve replacement through small incision), transcatheter pulmonary valve replacement (TPVR)
Endovascular Methods	Percutaneous pulmonary valve replacement (PPVR), especially in patients with previous conduit placement or bioprosthetic valve dysfunction
Cover Options	Mechanical valves (require lifelong anticoagulation), bioprosthetic valves (limited lifespan, usually 10-15 years)
Complications	Bleeding, infection, valve dysfunction, arrhythmia, thrombosis, pulmonary artery stenosis, valve migration
Postoperative Follow-up	Regular echocardiography controls, anticoagulant therapy compliance, infective endocarditis prophylaxis, lifestyle modifications
Long Term Follow-up	Monitoring of valve function, evaluation of right ventricular function, re-intervention planning if necessary

Where is the Heart Valve?

Pulmoner Kapak Hastalığı — Pulmonary Valve Disease

The pulmonary valve is a 3-leaflet valve at the beginning of the vein that sends dirty blood from the right ventricle to the lungs. It ensures that the blood flows in the right direction and does not escape back to the heart. Problems such as pulmonary valve stenosis and pulmonary valve insufficiency can occur. Pulmonary valve diseases are mostly congenital. Absence of a pulmonary valve and pulmonary valve stenosis are the most common problems. Depending on the condition of the problem in the pulmonary valve, pulmonary valve repair or pulmonary valve replacement are among the treatment options.

1,2,3-4 Degree Pulmonary Valve Insufficiency

The degrees of tricuspid regurgitation are as follows:

1. Degree (Light)

Mild blood leakage.
Small jet area on echocardiography.
Usually asymptomatic, follow-up is sufficient.

2. Grade (Medium)

Significant jet flow is observed, but right heart enlargement is absent or minimal.
There may be mild symptoms during exertion (fatigue, mild shortness of breath).
Regular follow-up is required.

3. Grade (Intermediate-advanced)

Jet flow is marked and enlargement of the right heart begins.
The patient develops edema, weakness and decreased effort capacity.
Drug treatment and close follow-up is recommended. Surgical intervention may be considered.

4. Degree (Advanced)

Severe back leakage, marked enlargement of the right heart chambers and loss of function.
Symptoms of severe right heart failure (severe edema, enlarged liver, shortness of breath, rapid fatigue).
Surgical intervention (valve repair or replacement) is usually unavoidable. It requires urgent treatment.

Pulmonary Valve Replacement

Pulmonary valve replacement is the replacement of the pulmonary valve with biological or mechanical artificial valves in cases where the patient’s pulmonary valve stenosis and insufficiency cannot be resolved by repair. It may be necessary to replace the valve in cases such as severe backward leakage or severe stenosis of the heart valves, sometimes both together, severe calcification of the valve, clots in front of the valve, heart rhythm disorders.

Pulmonary Valve Disease Treatment Methods

Stenosis of the pulmonary valve can be corrected with balloon application from the groin if the valve is suitable. In the absence, severe stenosis and insufficiency of the pulmonary valve, pulmonary replacement is required. In the treatment of pulmonary valve diseases, the heart valve is sometimes repaired and sometimes completely replaced with advanced techniques. This is done with minimally invasive surgical techniques, with a small incision of 4 centimeters in the side, under the arm, or if the lungs are bad, with a small incision of 4-5 centimeters in the front to repair or replace the heart valve.

Things to Consider After Pulmonary Valve Surgery

One of the most important issues after pulmonary valve surgery and replacement is the regular use of blood thinners as recommended by the physician. While the use of blood thinners in biological valve replacement is 3 months, in mechanical valve replacement, patients should use blood thinners for life. In cases such as surgical interventions due to another disease, it is important for the patient to contact the cardiologist and take preventive measures against infection. In addition, the patient should have regular medical check-ups to monitor the heart and heart valve.

Since pulmonary valve diseases can cause heart failure, early diagnosis and treatment is extremely important.

Shortness of breath
Fatigue
Palpitations
Arrhythmia

The definitive diagnostic test for pulmonary valve disease is ultrasound of the heart, i.e. echocardiography.

Pulmonary valve diseases can be caused by

It is usually congenital.
Rheumatic pulmonary valve involvement may rarely cause pulmonary valve disease.
Distortion of the pulmonary valve leaflets as a result of pulmonary vasodilation due to pulmonary tension

Symptoms that occur in pulmonary valve diseases due to stenosis or insufficiency are as follows:

Shortness of breath
Quick fatigue
Palpitations
Arrhythmia

Frequently Asked Questions

What is a pulmonary valve?

The pulmonary valve is the valve between the right ventricle of the heart and the pulmonary artery to the lungs that prevents blood from escaping backwards.

Which problems with the pulmonary valve require surgery?

Conditions such as severe stenosis or insufficiency of the pulmonary valve may require surgical intervention.

Why is pulmonary valve surgery performed?

It is done to ensure adequate blood supply to the lungs, reduce the burden on the heart and protect heart function.

Who undergoes pulmonary valve surgery?

It can be applied to children with congenital heart disease, adults with valve deformity and patients with advanced valve dysfunction.

How is pulmonary valve surgery performed?

It is performed as valve repair or valve replacement. It is sometimes performed through open heart surgery and sometimes through a catheter.

Prefer valve repair or replacement?

Repair is preferred if possible. However, if the valve is severely damaged, it is replaced with a mechanical or biological valve.

What is the difference between mechanical and biological valve?

Mechanical valves are durable but require lifelong blood thinners. Biological valves have a shorter lifespan, but usually do not require blood thinners.