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(Circulation. 1963;28:288.)
© 1963 American Heart Association, Inc.

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Pulmonary Stenosis

Electrocardiographic, Vectorcardiographic, and Catheterization Data

LEONARD SCHERLIS M.D.¹; ROLF J. KOENKER M.D.¹; YU-CHEN LEE M.D.¹

¹ From the Division of Cardiology, Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland.

The electrocardiographic, vectorcardiographic, and right heart catheterization data of 100 patients with isolated or complicated pulmonary stenosis were analyzed.

All but two patients had normal sinus rhythm. One patient, age 62, had atrial fibrillation; the other, age 8, had the Wolff-Parkin-son-White syndrome.

In isolated pulmonary stenosis, P-wave enlargement was far more frequently seen in those patients with right ventricular systolic pressures above 100 mm. Hg as compared to those with pressures less than 100 mm. Hg. This relationship was not observed in patients with complicated pulmonary stenosis.

The incidence of rsR' in V₁, QRS widening, and the vectorcardiographic evidence of conduction delay was significantly lower in pulmonary stenosis, isolated or complicated, when compared to atrial septal defects alone. There was one instance of terminal conduction delay of the right bundle-branch block type and one diffuse slowing of the QRS sÊ loop in the present series.

The correlation between the amplitude of the R wave in V₁ and right ventricular systolic pressure was better in the group of isolated pulmonary stenosis as compared to the groups complicated by interatrial communications or ventricular septal defects.

The average right ventricular systolic pressures in patients with type 3 right ventricular hypertrophy was significantly higher than those with either type 1 or type 2 right ventricular hypertrophy on the basis of vectorcardiographic criteria discussed. In the presence of pulmonary stenosis, the electrocardiographic and vectorcardiographic evidence of left ventricular hypertrophy or combined ventricular hypertrophy suggests coexisting lesions such as ventricular septal defect with left-to-right shunts. However, it was not possible to differentiate between isolated pulmonary stenosis and pulmonary stenosis complicated by interatrial communication by either electrocardiograms or vectorcardiograms.

The vectorcardiographic features of combined ventricular hypertrophy are discussed.