Pulmonary regurgitation

Last reviewed: September 2018

Last updated: December 2017

Summary

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 dyspnea, easy fatigability, and intermittent chest pain.

Transthoracic echo, transesophageal 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.

Definition

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, such as endocarditis. The murmur of pulmonary regurgitation is diastolic and is associated with RV lift. [1]

History and exam

Other diagnostic factors

dyspnea
decreased exercise tolerance
diastolic murmur
orthopnea
paroxysmal nocturnal dyspnea
palpitations
fatigue
diaphoresis
displaced point of maximal apical impulse
systolic murmur
signs of right-sided heart failure

Full details

Risk factors

pulmonary HTN
surgical repair of tetralogy of Fallot, pulmonary stenosis, or pulmonary atresia
endocarditis
left-sided heart disease
previous Ross procedure (with prosthetic pulmonary valve, homograph valve replacement)
collagen vascular disease
malignancies that involve the main pulmonary artery

Full details

Diagnostic investigations

1st investigations to order

ECG
transthoracic Doppler echocardiogram (TTE)
CXR

Full details

Investigations to consider

transesophageal Doppler echocardiogram (TEE)
MRI chest
CT scan chest
cardiac MRI

Full details

Treatment algorithm

ACUTE

acute pulmonary regurgitation

ONGOING

chronic pulmonary regurgitation

Contributors

Authors VIEW ALL 

Sachin S. Goel, MD

Interventional Cardiology

Prairie Heart Institute at St John's Hospital

Springfield

Disclosures

SSG declares that he has no competing interests.

Samir Kapadia, MD

Director of Cardiac Cath Lab

Professor of Medicine

Cleveland Clinic

Department of Cardiovascular Medicine

Cleveland

Disclosures

SK declares that he has no competing interests.

Acknowledgements

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.

Peer reviewers VIEW ALL 

Satish Adwani, MD

Consultant in Paediatric Cardiology and Adults with Congenital Heart Disease

John Radcliffe Hospital

Oxford

Disclosures

SA declares that he has no competing interests.

Sarabjeet Singh, MD

Cardiology Fellow

Adult Cardiovascular Fellowship

Department of Cardiology

Chicago Medical School (CMS) and affiliated hospitals

Chicago

Disclosures

SS declares that he has no competing interests.

Debabrata Mukherjee, MD

Gill Foundation Professor of Interventional Cardiology

Director of Cardiac Catheterization Laboratories

Gill Heart Institute

Division of Cardiovascular Medicine

University of Kentucky

Lexington

Disclosures

DM declares that he has no competing interests.

Syed Wamique Yusuf, MD, MRCPI, FACC

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

Disclosures

SWY declares that he has no competing interests.

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Pulmonary regurgitation

Summary

Definition

History and exam

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

acute pulmonary regurgitation

chronic pulmonary regurgitation

Contributors

Authors VIEW ALL 

Sachin S. Goel, MD

Disclosures

Samir Kapadia, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Satish Adwani, MD

Disclosures

Sarabjeet Singh, MD

Disclosures

Debabrata Mukherjee, MD

Disclosures

Syed Wamique Yusuf, MD, MRCPI, FACC

Disclosures

Differentials

Guidelines

Patient leaflets

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