The pulmonary valve is the heart valve located between the right ventricle and the pulmonary artery, which is the blood vessel that delivers blood to the lungs to be re-oxygenated. Like the tricuspid and aortic valves, the pulmonary valve is comprised of three flaps called cusps.

Two diseases can affect the pulmonary valve. The first is pulmonary stenosis, which occurs when the pulmonary valve stiffens, narrows and obstructs blood from flowing from the right ventricle to the pulmonary artery. Depending upon the extent of the condition, pressure may increase in the right ventricle and blood may not able to pump to the lungs normally.

The second condition is called pulmonary regurgitation (or pulmonary insufficiency). The pulmonary valve doesn't close correctly, which causes blood to regurgitate back into the right ventricle. In severe instances, this condition to can cause right side heart failure. Prognosis for both of these conditions depends upon the severity of the condition and the illness that causes it to develop.

Pulmonary valve regurgitation and pulmonary stenosis may not cause symptoms, but when the condition becomes severe, patients may experience:

• Shortness of breath (especially during or after physical activity)
• Light headed feeling, dizziness, fainting
• Chest pain
• Poor weight gain in infants
• Palpitations
• Arrhythmia, fast heartbeat
• Congestive heart failure symptoms (when pulmonary regurgitation is severe), such as shortness of breath, pain on right side of abdomen, edema, cold skin, bluish skin

Pulmonary valve regurgitation and pulmonary stenosis may not cause symptoms, but when the condition becomes severe, patients may experience:

• Shortness of breath (especially during or after physical activity)
• Light headed feeling, dizziness, fainting
• Chest pain
• Poor weight gain in infants
• Palpitations
• Arrhythmia, fast heartbeat
• Congestive heart failure symptoms (when pulmonary regurgitation is severe), such as shortness of breath, pain on right side of abdomen, edema, cold skin, bluish skin

Your physician may suspect pulmonary valve disease after listening to your heart with a stethoscope and conducting a thorough physical exam. If you physician suspects pulmonary valve stenosis or regurgitation, he or she may order one or more of the following tests:

• Echocardiogram
• EKG
• Chest X-ray
• Transesophageal echocardiogram (TEE)
• Diagnostic cardiac catheterization
• MRI

Treatment for both pulmonary stenosis and insufficiency may include:

• Endocarditis prevention, including preventive antibiotics before dental work and medical procedures
• Drug therapy to treat heart arrhythmias and heart failure, which are sometimes complications of this condition (diuretics, vasodilators, beta blockers, digoxin, nitrates, antiarrhythmia, anticoagulants)
• Physical activity restrictions
• Surgical repair or replacement of the valve
• Valvuloplasty (cardiac catheterization therapy opens the heart valve)

Aside from endocarditis prevention, including preventive antibiotics prior to dental procedures, patients with mild or absent symptoms may experience few complications and require no therapeutic treatment. If you're diagnosed with this condition, inform all of your physicians and dentist of your diagnosis. Your primary care physician and/or cardiologist will want to monitor your condition closely. Be sure to follow-up regularly and obtain all recommended tests. Your treatment may also encompass therapy for complications that can occur with pulmonary valve disease, such as atrial fibrillation, pulmonary hypertension, pulmonary emboli, stroke, heart failure, etc.

In the case of pulmonary stenosis, in particular, surgery is often required, and in fact, it's often performed on infants so the problem can be corrected early in life. Symptomatic patients with pulmonary valve regurgitation may also require surgery to repair or replace the heart valve.