Timeframe: from diagnosis of pulmonary stenosis until referral for surgical/interventional therapy or to the adult congenital heart disease team

Setting: outpatient setting, inpatient setting, and emergency department

Including:

initial assessment based on clinical history and physical examination

identification of causes and differential diagnosis

performance and interpretation of basic diagnostic modalities

interpretation of additional diagnostic modalities

medical therapy

Excluding: performing interventional or surgical therapy

• Medical expert

• Communicator

• Collaborator

• Scholar

• List the causes of PS and the commonly associated congenital cardiac malformations

• Describe the haemodynamics of PS

• Describe the pathophysiology of right ventricular outflow tract obstruction and its interaction with other congenital malformations

• Describe the symptoms and clinical signs of PS to the underlying anatomy and pathophysiology

• Outline the natural history and prognosis of isolated valvular PS

• Describe the values and limitations of diagnostic modalities in particular echocardiography

• Quantify the severity of PS and its effect on cardiac function

• Plan the follow-up and conservative management of a patient with isolated valvular PS

• Explain the current guidance on endocarditis prophylaxis

• Describe the indications, benefits, and risks of conservative, interventional, and surgical therapy for isolated valvular PS

• Take relevant history and perform an appropriate clinical examination

• Select appropriate investigations

• Perform and interpret the following diagnostic modalities:

  •   – ECG

  •   – Exercise ECG

  •   – Cardiopulmonary exercise testing

  •   – Transthoracic echocardiography

• Interpret the following diagnostic modalities:

  •   – Chest X-ray

  •   – Trans-oesophageal echocardiography

  •   – Cardiac catheterization

  •   – Coronary angiography

  •   – Cardiac CT

  •   – Cardiac MR

• Manage follow-up in collaboration with the adult congenital heart disease team

• Refer appropriate patients for interventional or surgical treatment

• Optimize patient condition in preparation of interventional or surgical therapy

• Evaluate symptoms carefully using patient history and exercise testing

• Apply only the diagnostic modalities required for reaching a definitive diagnosis or for planning a therapeutic intervention

• Educate and inform the patient in collaboration with adult congenital heart disease team

• Commit to collaborate with adult congenital heart disease team

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion)

• 4. Distant supervision