Any disease of the left side of the heart or the lungs that results in significant pulmonary HTN and dilated pulmonary arteries may lead to acquired pulmonary regurgitation. Pulmonary regurgitation may also be due to a congenital defect.
Acquired pulmonary valve regurgitation also typically results from surgical repair of tetralogy of Fallot, pulmonary stenosis, or atresia.
Isolated pulmonary regurgitation is rarely symptomatic; however, large regurgitant volume in the presence of dilated right ventricle may be associated with exertional dyspnoea, easy fatigability, and intermittent chest pain.
Trans-thoracic echo, trans-oesophageal echo, and MRI are essential to determine the severity and mechanism of pulmonary regurgitation.
In symptomatic patients with severe regurgitation, pulmonary valve replacement should be considered.
Pulmonary regurgitation is rare and is infrequently symptomatic. It gradually develops over many years and results in volume overload and right ventricular (RV) dysfunction. It can be congenital or acquired, caused by conditions that increase pulmonary artery pressure, such as left ventricular (LV) dysfunction or severe lung disease. The acquired form occurs from any secondary cause that leads to pulmonary regurgitation through increased pulmonary pressure secondary to left-sided failure, or after surgical intervention for tetralogy of Fallot, pulmonary stenosis, or pulmonary atresia. Isolated pulmonary regurgitation occurs as a result of any cause that impacts the valve directly: for example, endocarditis. The murmur of pulmonary regurgitation is diastolic and is associated with RV lift. 
Prairie Heart Institute at St John's Hospital
SSG declares that he has no competing interests.
Director of Cardiac Cath Lab
Professor of Medicine
Department of Cardiovascular Medicine
SK declares that he has no competing interests.
Dr Sachin S. Goel and Dr Samir Kapadia would like to gratefully acknowledge Dr Mehdi H. Shishehbor, the previous contributor to this monograph. MHS declares that he has no competing interests.
Consultant in Paediatric Cardiology and Adults with Congenital Heart Disease
John Radcliffe Hospital
SA declares that he has no competing interests.
Adult Cardiovascular Fellowship
Department of Cardiology
Chicago Medical School (CMS) and affiliated hospitals
SS declares that he has no competing interests.
Gill Foundation Professor of Interventional Cardiology
Director of Cardiac Catheterization Laboratories
Gill Heart Institute
Division of Cardiovascular Medicine
University of Kentucky
DM declares that he has no competing interests.
University of Texas MD Anderson Cancer Center
Department of Cardiology
SWY declares that he has no competing interests.
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