Simple Pulmonary Stenosis

Simple pulmonary stenosis is relatively common.Wood (1950) considers it to account for 12 per cent of cases of congenital heart disease and Campbell (1954) gives the figure of 10 per cent.The two largest series of cases to be reported are those of Abrahams and Wood (1951) 69 cases, and Campbell (1954) 100 cases.This paper deals with a consecutive series of 33 cases.The clinical features are briefly reviewed and evidence is sought to define more clearly the natural history of the disease.The age and sex distribution of the 33 cases are shown in Table I.All but one of them were originally referred to hospital as a result of a routine medical'examination at school or at ante-natal TABLE I SIMPLE PULMONARY STENOSIS AGES AT THE TIME OF REVIEW, AND SEX DISTRIBUTION Age in years No. of cases Male Female 0-10 9 3 6 11-20 15 12 3 21-37 9 1 8 Total 33 16 17clinics.Fifteen have been followed for more than 5 years and a further eleven for from 10 to 21 years.The children were seen at six-monthly or yearly intervals until they left school and there- after less frequently.Three were referred back to the clinic during pregnancy and others returned specifically for the present review.SYMPTOMS Twenty-three patients had no symptoms.They led unrestricted lives and took part in every activity, including competitive sport, without handicap.Of the remaining ten patients nine complained of breathlessness.As in other types of heart disease the assessment of breathlessness was sometimes difficult; in every case heart disease had been diagnosed early, and because of this, some of the children had been restricted at school and at home, and in two patients other features of cardiac neurosis were present.It seemed clear, however, that the breathlessness was genuine in at least six, and three were considerably handicapped.In one of these three, physical capacity was limited, not only by breathlessness, but also by central chest pain, which was constantly related to more severe exertion.A second also complained of fainting attacks after effort.Additional features were failure to gain weight (1 case) and mental defectiveness (2 cases).Pulmonary stenosis was not considered to be the cause of these two conditions.