Treatment of Pulmonary Valve Stenosis in Germany
Best hospitals and doctors for pulmonary valve stenosis treatment in Germany
Leading hospitals
Cost for treatment
An abnormal decrease in the lumen of the pulmonary artery can be present in any part of this vessel. The specialists often encounter stenosis of the pulmonary artery valve. However, the decreased lumen can also be localized above or below the valve, among the branches of the pulmonary artery (peripheral stenosis). The disease is caused by hereditary factors or can be acquired. If pulmonary valve stenosis in patients manifests itself with severe symptoms, surgical intervention should be performed immediately.
Content
- Overview
- Why does pulmonary valve stenosis occur?
- Symptoms of pulmonary valve stenosis
- Diagnostics for pulmonary valve stenosis
- Pulmonary valve stenosis treatment tactics
- Replacement surgery for treatment
- Treatment in hospitals in Germany
- The cost of treatment in Germany
- Treatment in Germany with Booking Health
Overview
This narrowing in pulmonary valve stenosis can occur at different levels, and depending on the location of the stenosis, the following types of pulmonary valve stenosis are distinguished:
- Valvular (narrowing of the pulmonary valve).
- Supravalvular (narrowing above the level of the valve).
- Subvalvular.
The pulmonary artery performs a vital function. It carries venous blood to the lungs, where gas exchange occurs and the blood is oxygenated. When there is a narrowing, the right ventricle has to work harder to get the proper volume of blood through the narrower opening. As a result, right ventricular hypertrophy develops. Blood enters the pulmonary artery more slowly than it normally should. Thus, the normal cycle of cardiac activity is disrupted.
The patient’s condition and the clinical picture of stenosis depend on the severity of this narrowing. When the artery is slightly narrowed, the defect may appear almost nothing, and patients feel okay. But if the condition is severe, surgery is necessary to correct it, because otherwise there is a real danger to the life of the patient.
With severe pulmonary valve stenosis, patients develop cyanosis. Dyspnea appears on physical load and even at rest.
Diagnostic methods are electrocardiogram, which gives a picture of right heart overload, X-ray, which shows changes in the lungs, and, mainly, echocardiogram, which allows doctors to anticipate the degree of stenosis.
Why does pulmonary valve stenosis occur?
There are two groups of factors that can cause isolated pulmonary artery stenosis.
The first group is hereditary factors. Congenital (intrauterine) heart defects are hereditary. As a rule, the patient's close relatives had or have some type of heart disease. Congenital heart defects are usually caused by pinpoint gene changes or changes in the chromosomes, the carriers of genetic information (chromosomal mutations).
Then there are environmental factors. In addition to genetic factors that contribute to the hereditary transmission of isolated pulmonary valve stenosis, the cardiac condition may occur under the influence of adverse environmental factors, such as:
- Physical mutagens (factors that cause mutation): mainly ionizing radiation that damages the DNA molecule, the carrier of hereditary information.
- Chemical mutagens: phenols, nitrates, benzpyrene (emitted when smoking tobacco), alcohol, and certain medication (antibiotics, anticancer drugs).
- Biological mutagens: rubella virus (infectious disease), diabetes, phenylketonuria (congenital disorders of amino acids exchange), systemic lupus erythematosus (a disease in which the immune system damages the tissues of the body).
Symptoms of pulmonary valve stenosis
A very pronounced (critical) stenosis in patients may manifest as cyanosis. Such patients require immediate surgical treatment. Non-specific stenoses may not manifest themselves, and such patients do not require any treatment. They are most often recommended routine monitoring by a doctor and periodic cardiac ultrasound to help monitor the progression of the stenosis.
Considering that the degree of the constriction varies, the level of compensation and the clinical severity in patients vary as well. The following signs are characteristic for this type of heart disease: rapid fatigue, general weakness, dizziness, constant daytime sleepiness, shortness of breath, palpitations. If this defect is congenital, then young patients have a gradual lag in physical development, they become susceptible to different diseases, most often of infectious nature. Sometimes fainting and sudden loss of consciousness in a stuffy room can occur.
The cardiologist may note the cervical veins of patients increasingly pulsating, their swelling at coughing, talking, and slight exertion. On palpation of the chest, a systolic tremor is noted. In advanced stages and a prolonged course of pathology, a heart hump may develop.
Diagnostics for pulmonary valve stenosis
In terms of diagnostics, external examination and palpation are informative (a systolic murmur may be found).
Some diagnostic tests that involve the following procedures are also indicated:
- Electrocardiography reveals deviation of the electrical axis of the heart to the right, as well as signs of right ventricular hypertrophy.
- Chest X-ray shows an enlargement of the right side of the heart and its weakening by the pulmonary pattern.
- Echocardiography detects increased pressure gradients on different sides of the level of obstruction.
- Cardiac ultrasonography helps detect hypertrophy of the right ventricle.
- Cardiac catheterization involves the direct assessment of pressure in the pulmonary artery. When a catheter is inserted from the pulmonary artery into the ventricle with stenosis, there is a sudden pressure spike.
- Angiocardiography is a radiologic examination of the heart and large vessels with the injection of a water-soluble contrast agent, which reveals the narrowing of the right ventricular exit port.
Pulmonary valve stenosis treatment tactics
Unfortunately, drug therapy is not able to eliminate the narrowing. However, during the preparation for surgery or for those for whom surgery is contraindicated, drugs are prescribed to eliminate congestion in the circulation. Preoperative therapy is carried out to improve hemodynamics. Some drugs are administered for this purpose exclusively in intensive care units and with the use of invasive management of arterial pressure.
If the course of the disease is quite aggressive, then surgical intervention may also be necessary. Its essence is to artificially dilate the valve’s orifice, thereby restoring blood flow. If such measures do not produce a positive effect, the patient is offered a total valve replacement – a surgery that has become commonplace in modern cardiology.
Surgery for pulmonary valve stenosis is not performed in every case diagnosed. If the disease is diagnosed at an early stage of progression, doctors adhere to surveillance tactics, which include reducing physical activity and taking specific medications that will prevent the development of acute heart failure.
The choice of surgery depends on the location of the stenosis. Only valve and peripheral (branch) pulmonary artery stenoses are subject to endovascular treatment, all the other variants of the pathology remain the prerogative of surgery.
Treatment of any type of pulmonary valve stenosis begins with an evaluation of the option of valve repair. The most common surgery of this type is called valvuloplasty. A thin tube is inserted into the pulmonary artery under X-ray guidance, through which a contrast agent is injected. This manipulation allows the location and extent of the stenosis to be determined. Then a folded balloon is then inserted into the pulmonary artery.
When the balloon reaches the site of the constriction, it is inflated, disconnecting the fused valve leaflets. The balloon is deflated and the catheter is removed. This procedure lasts on average about one hour. Only the femoral vein puncture mark remains on the patient's body after this procedure.
Endovascular treatment of stenoses in the branches of the pulmonary artery is also possible. Such stenoses are extremely rare as isolated defects. More often, branch stenoses are combined with other congenital heart defects or are the consequences of surgery for stenosis correction. In this case, branch stenoses are eliminated by angioplasty of pulmonary artery branches. Similar to valve stenosis, a catheter with a balloon at the end is inserted into the site of the narrowing under X-ray guidance. The balloon is inflated by stretching the constriction site. The effectiveness of the intervention is assessed after a contrast agent is injected into the pulmonary artery and pressure at different points of the vessel is measured. Balloon angioplasty alone is often not sufficient due to the high elasticity of the vessels (when the vessel walls take their former shape after expansion).
As a rule, the operation lasts 1-1,5 hours if no complicated anatomical variations are present. Then the duration increases. For patients with pulmonary stenosis, such endovascular interventions are performed under local anesthesia. Children and patients who experience severe anxiety before the operation are under general anesthesia.
So, can patients return to physically active life after surgery for pulmonary valve stenosis?
If the surgical treatment and rehabilitation period went well and body function is restored, there are usually no contraindications to being physically active. However, regular examinations and monitoring by a cardiologist are necessary to control the state of the cardiovascular system and the degree of obstruction.
Replacement surgery for treatment
After the correction of congenital heart disease by the means of surgical intervention requiring reconstruction of the outflow pathway, physicians often observe complications that are linked to pulmonary artery deformity. As a consequence, the right ventricle is under even more increased load significantly because it is put under pressure to generate more effort to expel blood through the deformed portion of the pulmonary artery. Reverse blood flow, associated with insufficiency of the flail apparatus, and manifested by the inability to fully close the valve cusps, can eventually lead to its irreversible dysfunction.
Transcatheter implantation or replacement surgery, for which pulmonary valve prosthesis has been designed, is a minimally invasive technique. It allows the affected pulmonary valve to be replaced without "open" surgery and artificial circulation. The prosthesis is delivered to the diseased part of the pulmonary vessel via a catheter. With this method of treatment, the complications associated with the use of artificial circulation are avoided. In addition, this approach significantly shortens the patient's hospital stay: two to three days after the intervention, the patient can return to daily life.
The main advantage of the prosthetic valve is durability and repositioning capability, which is important for this anatomical area. The flap device, fixed to the body, is created from an anti-calcium-treated biological material. The valve delivery system is thin, which makes it possible to implant transcatheter valve prosthesis in children weighing less than 30 kg. There is even a possibility of the transcatheter prosthesis to be manufactured individually for each patient, taking into account all anatomical characteristics, which will increase the effectiveness of treatment of pathology of the outflow pathway to the pulmonary artery.
Treatment in hospitals in Germany
Cardiology hospitals in Germany provide comprehensive, personalized medical care for children with all types of congenital heart defects. Local doctors are experienced in the treatment of pulmonary stenosis of any degree of severity in children, and adults. In addition, there is the possibility of intrauterine correction of the defect.
Treatment of pulmonary valve stenosis in Germany involves the use of modern medications and minimally invasive techniques. Whenever possible, surgeries are performed through small incisions, which minimize the risk of complications and shorten the recovery period of patients. Hospitals in Germany are world leaders in developing and refining new surgical approaches, so local doctors use minimally invasive surgery as a safe and effective alternative to open surgery. Treatment is performed in hybrid operating rooms, equipped with the latest technology, allowing German surgeons to successfully perform even the most complex interventions.
The best hospitals for pulmonary valve stenosis treatment in Germany are:
- University Hospital Oldenburg.
- University Hospital Essen.
- University Hospital Ulm.
- University Hospital Frankfurt am Main.
- University Hospital Tuenbingen.
You can learn more about each hospital by visiting the hospital section of the Booking Health website.
The cost of treatment in Germany
The cost of treatment in Germany is calculated for patients individually but on the basis of the universal pricing system.
The final cost of treatment is drawn up after discharge at the end of therapy. At this stage, the pre-agreed price may change. Depending on the additional therapeutic and diagnostic services prescribed, it may increase. If the actual amount spent is less than it was originally planned, the price is recalculated, and the difference is returned to the client.
The prices for pulmonary valve stenosis diagnosis start at 463 EUR.
The cost of treatment with valvuloplasty starts at 5,333 EUR.
The cost of treatment with valve replacement surgery starts at 9,964 EUR.
The cost of treatment with valve reconstruction starts at 9,785 EUR.
To send a request for a cost estimate for a treatment program at a German clinic, we recommend preparing documents with the results of instrumental and laboratory tests, as well as medical reports on the material of examinations conducted in the place of residence recently.
Treatment in Germany with Booking Health
Organizational issues are no less important for your successful, efficient, and comfortable stay in hospitals in Germany. Even a perfectly healthy person finds it difficult to navigate in an unfamiliar country, overcome language barriers and numerous routine issues.
Booking Health provides patients assistance in the organization of treatment in Germany, dealing with all the issues that may arise during the treatment of pulmonary valve stenosis in Germany so that patients could concentrate on their recovery.
If you want to know more about the services Booking Health provides, fill in the request form on the Booking Health website so that we could contact you.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed