Andersons pediatric cardiology 1132

FIG 42.40 Bethesda Classification of sports The lowest total cardiovascular demands (cardiac output and blood pressure) are shown in green and the highest in red Blue, yellow, and orange depict lowmoderate, moderate, and high-moderate total cardiovascular demands *Danger of bodily collision †Increased risk if syncope (From Mitchell JH, Haskell W, Snell P, et al Task Force 8: Classification of sports J Am College Cardiol 2005;45:1364–1367.) Asymptomatic patients with untreated pulmonary stenosis with peak Doppler systolic gradients of less than 40 mm Hg are encouraged to live a normal life, including any competitive sports Patients with gradients greater than 40 mm Hg can participate in low-intensity competition but would usually be considered for intervention After Intervention for Pulmonary Stenosis Following balloon dilation, the return to all competitive sports can be counseled in patients with no or mild residual stenosis 2 to 4 weeks after the procedure A longer interval of about 3 months is recommended after surgical relief Those with residual moderate pulmonary stenosis, with a gradient of greater than 40 mm Hg, should follow the same recommendations as patients prior to intervention Patients with severe pulmonary incompetence and right ventricular enlargement are recommended only to participate in IA and IB classified sports Care to avoid blows to the chest would be prudent.159 Implications in Adult Life Without intervention, patients with pulmonary stenosis can survive into adult life, as they generally do in countries with less well-developed health care systems In a retrospective study of 20 years in a developing country, pulmonary stenosis accounted for 6% of unoperated adults presenting with congenitally malformed hearts.161 Although there are few data in the literature, persistent and slowly progressive obstruction of the right ventricular outflow tract has led to anecdotal reports of severely debilitated patients with low cardiac output and right heart failure, particularly in developing countries The same anecdotal reports show that, despite catastrophic existing morbidity, a successful intervention to relieve pulmonary stenosis can yield rapid and impressive improvements in the clinical state