Diseases of the Pulmonary Valve: Interventional and Surgical Therapeutic Options

Diseases of the pulmonary valve (PV) are more prevalent in pediatric cardiology and comprise a rare entity in daily adult cardiac care. Most common are congenital defects. Acquired malfunctions of the PV are usually associated with an already degenerated bioprosthesis in the corresponding anatomical position. Patients can remain asymptomatic for decades due to specific hemodynamic compensatory capacities of the right heart. Echocardiography is the first-line investigation. Moreover complex, multimodality imaging is often used to guide therapeutic decisions. Those should be based on the clinical presentation and the degree of severity. If possible, an interventional approach should be preferred to a surgical procedure, especially in patients with previous heart surgery. The procedure and the recommended life-long and regular follow-ups should be conducted in specialized centers for grown-ups with congenital heart disease. In daily clinical practice, endocarditis prophylaxis and anticoagulation after successful valve replacement remain relevant.