Any disease of the left side of the heart or the lungs that results in significant pulmonary hypertension 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 magnetic resonance imaging 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 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.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- decreased exercise tolerance
- diastolic murmur
- paroxysmal nocturnal dyspnoea
- displaced point of maximal apical impulse
- systolic murmur
- signs of right-sided heart failure
- pulmonary hypertension
- surgical repair of tetralogy of Fallot, pulmonary stenosis, or pulmonary atresia
- left-sided heart disease
- previous Ross procedure (with prosthetic pulmonary valve, homograft valve replacement)
- collagen vascular disease
- malignancies that involve the main pulmonary artery
1st investigations to order
- trans-thoracic Doppler echocardiogram (TTE)
Investigations to consider
- trans-oesophageal Doppler echocardiogram (TEE)
- MRI chest
- CT scan chest
- cardiac MRI
acute pulmonary regurgitation
chronic pulmonary regurgitation
- Mitral stenosis
- Aortic regurgitation (AR)
- Atrial myxoma
- 2018 AHA/ACC guidelines for the management of adults with congenital heart disease
- 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease
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