Health Encyclopedia

Search the Health Encyclopedia

Absent pulmonary valve

Definition

Absent pulmonary valve is a rare defect in which the pulmonary valve is either missing or poorly formed. Oxygen-poor blood flows through this valve from the heart to the lungs, where it picks up fresh oxygen. This condition is present at birth (congenital).

Alternative Names

Absent pulmonary valve syndrome; Congenital absence of the pulmonary valve; Pulmonary valve agenesis; Cyanotic heart disease - pulmonary valve; Congenital heart disease - pulmonary valve; Birth defect heart - pulmonary valve

Causes

Absent pulmonary valve occurs when the pulmonary valve does not form or develop properly while the baby is in the mother's womb. When present, it often occurs as part of a heart condition called tetralogy of Fallot. It is found in about 3% to 6% of people who have tetralogy of Fallot.

When the pulmonary valve is missing or does not work well, blood does not flow efficiently to the lungs to get enough oxygen.

In most cases, there is also a hole between the left and right ventricles of the heart (ventricular septal defect). This defect will also lead to low-oxygen blood being pumped out to the body.

The skin will have a blue appearance (cyanosis), because the body's blood contains a low amount of oxygen.

Absent pulmonary valve also results in very enlarged (dilated) branch pulmonary arteries (the arteries that carry blood to the lungs to pick up oxygen). They can become so enlarged that they press on the tubes that bring the oxygen into the lungs (bronchi). This causes breathing problems.

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

Heart problems that occur with absent pulmonary valve may be due to defects in certain genes.

Symptoms

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

  • Blue coloring to the skin (cyanosis)
  • Coughing
  • Failure to thrive
  • Poor appetite
  • Rapid breathing
  • Respiratory failure
  • Wheezing

Exams and Tests

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 exam, the health care provider may hear a murmur in the infant's chest.

Tests for absent pulmonary valve include:

  • A test to measure the electrical activity of the heart (electrocardiogram)
  • Heart CT scan
  • Chest x-ray
  • Echocardiogram
  • Magnetic resonance imaging (MRI) of the heart

Treatment

Infants who have respiratory symptoms typically need surgery early. Infants without severe symptoms most often have surgery within the first 3 to 6 months of life or later.

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

  • Closing the hole in the wall between the left and right ventricles of the heart (ventricular septal defect)
  • Closing a blood vessel that connects the aorta to the pulmonary artery (ductus arteriosis)
  • Enlarging the flow from the right ventricle to the lungs

Types of surgery for absent pulmonary valve include:

  • Moving the pulmonary artery to the front of the aorta and away from the airways
  • Rebuilding the artery wall in the lungs to reduce pressure on the airways (pulmonary plication and reduction arterioplasty)
  • Rebuilding the windpipe and breathing tubes to the lungs
  • Replacing the abnormal pulmonary valve with one taken from human or animal tissue

Infants with severe breathing symptoms may need to get oxygen or be placed on a breathing machine (ventilator) before and after surgery.

Outlook (Prognosis)

Without surgery, there may be a risk for serious consequences.

In many cases, surgery can treat the condition and relieve symptoms. Outcomes are most often very good.

Possible Complications

Complications may include:

  • Brain infection (abscess)
  • Lung collapse (atelectasis)
  • Pneumonia
  • Right-sided heart failure
  • Stroke

When to Contact a Medical Professional

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

Prevention

Although there is no way to prevent this condition, families may be evaluated to determine their risk for congenital defects.

References

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Acyanotic congenital heart disease: regurgitant lesions. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 455.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Cyanotic congenital heart lesions: lesions associated with decreased pulmonary blood flow. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 457.

Scholz T, Reinking BE. Congenital heart disease. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 55.

Valente AM, Dorfman AL, Babu-Narayan SV, Krieger EV. Congenital heart disease in the adolescent and adult. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 82.

Review Date:2/23/2022
Reviewed By:Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.

Health Outcome Data

No data available for this condition/procedure.

Health Encyclopedia

More Features