Postvalvular Stenosis of the Pulmonary Artery

Constrictive lesions of the pulmonary artery or its branches occur distal to the pulmonic valve. Four patients whose surgical or cardiac catheterization findings demonstrated such postvalvular stenosis are reported. The significance of such findings is discussed and diagnostic misinterpreta-tions are mentioned. RECENT reports have focused attention on the occasional occurrence of localized constrictions in the pulmonary vascular system distal to the valve of the pulmonary artery. Such lesions have been called "coarctation of the pulmonary artery."'-3 We believe the less specific term "postvalvular stenosis " to be somewhat more inclusive and more descriptive of these defects. Schumacher and Lurie4 have described a calcified stenotic lesion at the bifurcation of the pulmonary artery. This constriction was subse-quently successfully dilated by spreading a Kelly clamp within the lumen of the artery. Sondergaard ' has reported 3 cases of similar constrictions of the bifurcation encountered at surgery during a 3-year period. In each case, a fibrotic band, believed to be the ligamentum arteriosum, was attached to the constriction. Arvidsson, Karnell, and Mdller ' have demon-strated multiple stenotic lesions of the periph-eral pulmonary vasculature in 4 patients by means of selective angiocardiography. Coles and Walker ' have presented a case of "coaretation of the pulmonary artery " that was diagnosed by cardiac catheterization and angiocardiography. They also mentioned a case of Hodges that presented a similar picture. Recently, Eldridge, SeIzer, and Hultgren6 have reported 5 patients with stenosis of a branch of the pulmonary artery. In Bailey's text2 is mentioned the exist-ence of localized strictures of the main pulmo-nary artery termed "coarctation." Since 1951 we have encountered 4 patients who apparently presented instances of this previously rarely reported anomaly