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Increased pulmonary congestion is characteristic of left-to-right shunts like VSD or left-sided failure like aortic stenosis. In pulmonary stenosis, the problem is that not enough blood is getting to the lungs; therefore, the lungs typically appear clear or under-circulated on a chest X-ray.

Left ventricular hypertrophy results in obstruction on the right side of the heart. The workload increases for the right ventricle, leading to right ventricular hypertrophy (RVH). The left ventricle is generally unaffected in size unless a secondary complication occurs.

Pulmonary stenosis is typically managed very successfully with balloon valvuloplasty or surgical valvotomy. A heart transplant is a last-resort treatment for end-stage heart failure or complex defects like Hypoplastic Left Heart Syndrome, not for a localized valvular obstruction like pulmonary stenosis.

Children with congenital heart defects are at a higher risk for complications from respiratory illnesses like the flu or pertussis. Staying up-to-date on immunizations is essential to protect them from infections that would further stress their cardiovascular system.Test-taking strategy● Identify the "acuity" of the defect: Pulmonary stenosis is an obstruction, but it is rarely a reason for a transplant. Look for treatments that match the defect that is repairing the valve.● General health principles: In pediatric nursing, you almost never delay vaccinations for a cardiac defect; if anything, the child needs them more urgently to prevent added stress.● Chronic vs. Acute: Follow-up care and monitoring are the "gold standards" for any parent education regarding a congenital structural heart issue.Take home points● Pulmonary stenosis is an obstructive lesion, meaning the heart has a "plumbing" problem that limits flow to the lungs.● Education should emphasize that the child can often lead a relatively normal life with proper monitoring.● Parents should be taught to report any cyanosis immediately, as this may indicate the shunt has reversed due to high right-sided pressure.

“It is normal for the child to be easily fatigued during feeding.” While fatigue is a symptom of the disorder, it is never normal or acceptable. Fatigue during feeding is a red-flag sign of heart failure in infants. It indicates that the heart cannot even handle the metabolic demand of eating, which is a sign that the stenosis is likely severe and needs intervention.

“I will encourage the child to participate in competitive sports in school.” Children with moderate to severe stenosis are usually restricted from competitive or high-intensity sports. Strenuous activity increases the demand for oxygenated blood, because the valve is narrowed, the heart has a fixed output and cannot meet that demand, which can lead to fainting or even sudden cardiac arrest.

“I will discontinue medications once the child appears asymptomatic.” Cardiac medications such as diuretics or afterload reducers must be taken exactly as prescribed. Often, a child appears asymptomatic because the medication is working. Abruptly stopping these drugs can lead to a rapid return of symptoms and acute heart failure.