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Chapter 13: THE ECHOCARDIOGRAM

RIGHT-SIDED VALVULAR DISEASE ANDPULMONARY HYPERTENSION Pulmonic Valve

Major structural abnormalities of the pulmonic valve are relatively rare. Pulmonic stenosis (PS) is usually congenital in origin and resembles congenital AS in many respects. The stenotic valve does not open fully and exhibits characteristic thickening and systolic doming on 2D imaging342 (Fig. 13-85). M-mode recordings of the pulmonic valve often show a large a wave, since right ventricular diastolic pressure is often so high and pulmonary artery (PA) pressure so low that the atrial "kick" is sufficient to open the pulmonic valve.343 Doppler interrogation reveals turbulent flow distal to the valve, and CW measurements can be used to calculate gradients and valve areas with the Bernoulli and continuity equations much as in aortic stenosis.344

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