COR LOE Recommendations I B-NR In adults with moderate or severe valvular pulmonary stenosis and otherwise unexplained symptoms of HF, cyanosis from interatrial right-to-left communication, and/ or exercise intolerance, balloon valvuloplasty I B-NR In adults with moderate or severe valvular pulmonary stenosis and otherwise unexplained symptoms of HF, cyanosis, and/ or exercise intolerance who are ineligible for or who failed balloon valvuloplasty, surgical repair is recommendedS4.3.1-1,S4.3.1-5 S4.3.1-8 IIa C-EO In asymptomatic adults with severe valvular pulmonary stenosis, intervention is reasonable. Synopsis Valvular PS is one of the most common congeni- tal heart defects, estimated to occur in up to 7% of children born with CHD.S4.3.1-9 S4.3.1-11 Some common findings associated with isolated valvular PS include a dilated main PA and dysplastic valve cusps. Surgical or catheter-based intervention depends on degree of obstruction, RV pressure and function, and associated symptoms. Patients with isolated pulmonary valve ste- nosis (native or recurrent after an intervention) require ongoing cardiac follow-up and monitoring for evi- dence of progressive valve stenosis or regurgitation, RV hypertrophy, HF, and arrhythmias.S4.3.1-12 Patients with mild native pulmonary valve stenosis (Table 22) have a reassuring natural history, and intervention is not usually necessary. Patients with severe PS (Table 22) usually require intervention in childhood with a good prognosis into adulthood.S4.3.1-6 Patients with moderate stenosis (Table 22) have more variable histories, with some having received surgical or catheter intervention in childhood or adulthood and some not. Patients with moderate PS, whether native or postintervention, have a good long-term outcome, although some will go on to require an intervention in adulthood because of pro- gressive PS or, commonly, significant PR as a sequela of earlier intervention. 