Exercise Stress Echocardiography-Guided Balloon Pulmonary Valvuloplasty for Pulmonary Valve Stenosis With a Moderate Pressure Gradient and Exercise Intolerance: A Case Report.

Current guidelines recommend balloon pulmonary valvuloplasty (BPV) for symptomatic adults with moderate or severe pulmonary valve stenosis (PVS) when the valve anatomy is suitable. However, when the resting gradient is near the lower boundary of the moderate range, establishing whether exercise intolerance is attributable to PVS can be challenging. We describe the case of a 52-year-old woman with longstanding PVS who developed progressive exercise intolerance. Resting echocardiography revealed a peak gradient of 38 mmHg, which remained stable during follow-up. Exercise stress echocardiography (ESE) demonstrated a blunted stroke volume response, whereas cardiopulmonary exercise testing (CPET) showed reduced peak VO2. Based on these objective findings, BPV was performed for symptomatic moderate PVS. Following successful intervention, both the stroke volume response and peak VO2 improved markedly. This case highlights that exercise-based diagnostic modalities, particularly ESE in conjunction with CPET, can help guide treatment decisions in symptomatic moderate PVS.