Pulmonary valve insufficiency

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Pulmonary valve insufficiency
Other names: Pulmonary regurgitation, pulmonary incompetence
PulmonaryRegurg.jpg
Diagram of the heart with a black arrow showing the location and direction of the abnormal blood flow
SpecialtyCardiology
SymptomsFew symptoms initially, may develop shortness of breath with exercise[1]
ComplicationsHeart failure, ventricular arrhythmia, tricuspid regurgitation[1]
CausesPulmonary hypertension, surgical valvulotomy, balloon valvuloplasty, carcinoid disease, infective endocarditis, rheumatic heart disease, congenital valve disease[1]
Diagnostic methodSuspected based on a diastolic murmur, confirmed by echocardiogram[1]
Differential diagnosisAortic regurgitation, pulmonary emboli, constrictive pericarditis[1]
TreatmentActive monitoring, pulmonary valve replacement[1]
FrequencySevere disease is rare[2]

Pulmonary valve insufficiency, also known as pulmonary regurgitation, is a type of valvular heart disease in which there is backward flow of blood from the pulmonary artery, through the pulmonary valve, into the right ventricle, when the heart relaxes.[1] Most people have no symptoms.[1] When symptoms do occur these may include shortness of breath with exercise, leg swelling, and an enlarged liver.[1] Complications may include heart failure, ventricular arrhythmia, and tricuspid insufficiency.[1]

Causes may include pulmonary hypertension, surgical valvulotomy, balloon valvuloplasty, carcinoid disease, infective endocarditis, rheumatic heart disease, or congenital valve disease.[1] It commonly occurs in people with tetralogy of Fallot as the surgery to correct the abnormality can result in pulmonary valve issues years later.[1] The diagnosis may be suspected based on a diastolic murmur and confirmed by an ultrasound of the heart.[1]

Yearly ultrasounds may be recommended in those at risk.[1] In those with pulmonary hypertension, that should be treated.[2] In those with symptoms, pulmonary valve replacement may be recommended.[1] The tricuspid valve may benefit from being repaired at the same time.[1] In those unable to have surgery, diuretics, ACE inhibitors, and beta-blockers may be used to treat heart failure.[1] Outcomes can be good with surgery.[1]

Severe pulmonary valve insufficiency is rare.[2] A small to moderate amount of back flow may normally occur.[1][3] The murmur of pulmonary valve insufficiency was first described in 1873 by George Balfour and later in 1888 by Graham Steell.[4][5] It was further described by William Osler in 1892, at which time it was considered of little importance.[6]

Signs and symptoms

Because pulmonic regurgitation is the result of other factors in the body, any noticeable symptoms are ultimately caused by an underlying medical condition rather than the regurgitation itself.[7] However, more severe regurgitation may contribute to right ventricular enlargement by dilation, and in later stages, right heart failure.[8] A diastolic decrescendo murmur can sometimes be identified,( heard best) over the left lower sternal border.[medical citation needed]

Causes

Rheumatic heart disease,

Among the causes of pulmonary insufficiency are:

Pathophysiology

The pathophysiology is due to diastolic pressure variations between the pulmonary artery and right ventricle, differences are often very small, but increase regurgitation. An elevation in pulmonary insufficiency due to elevated intrathoracic pressure is relevant in ventilated patients (having acute restrictive right ventricular physiology). The reasons for changes in stiffness of the right ventricle's walls are not well understood, but such stiffness is thought to increase with hypertrophy of the ventricle.[13]

Diagnosis

In the diagnosis of pulmonary insufficiency both echocardiograms and EKG is used to ascertain if the individual has this condition, as well as, the use of a chest x-ray to expose enlargement of the right atrium or ventricle.[14]

If it is secondary to pulmonary hypertension it is referred to as a Graham Steell murmur.[15]

Treatment

In treating pulmonary insufficiency, it should be determined if pulmonary hypertension is causing the problem to therefore begin the most appropriate therapy as soon as possible (primary pulmonary hypertension or secondary pulmonary hypertension due to thromboembolism).[16] Furthermore, pulmonary insufficiency is generally treated by addressing the underlying condition,[7] in certain cases, the pulmonary valve may be surgically replaced.[17]

See also

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Saji, AM; Sharma, S (January 2020). "Pulmonary Regurgitation". PMID 32491496. Cite journal requires |journal= (help)
  2. 2.0 2.1 2.2 "Pulmonic Regurgitation - Cardiovascular Disorders". Merck Manuals Professional Edition. Retrieved 22 December 2020.
  3. Gill, Edward A.; Sugeng, Lisa; Lang, Roberto (2012). Atlas of 3D Echocardiography E-Book: Expert Consult – Online. Elsevier Health Sciences. p. 176. ISBN 978-1-4557-4238-7.
  4. Elwood, Willis J.; Tuxford, Ann Félicité (1984). Some Manchester Doctors: A Biographical Collection to Mark the 150th Anniversary of the Manchester Medical Society. Manchester University Press. p. 210. ISBN 978-0-7190-1754-4.
  5. III, James A. Stockman (2012). Year Book of Pediatrics 2012 - E-Book. Elsevier Health Sciences. p. 231. ISBN 978-0-323-08974-6.
  6. MD, Joseph K. Perloff; Marelli, Ariane (2012). Perloff's Clinical Recognition of Congenital Heart Disease: Expert Consult - Online and Print. Elsevier Health Sciences. p. 169. ISBN 978-1-4377-1618-4.
  7. 7.0 7.1 McGlothlin, edited by Michael H. Crawford, Komandoor Srivathson, Dana P. (2006). Current consult. New York, NY: Lange Medical Books/McGraw-Hill. p. 269. ISBN 978-0-07144-010-3.CS1 maint: extra text: authors list (link)
  8. 8.0 8.1 8.2 "Pulmonic Regurgitation Clinical Presentation". Medscale.com. eMedicine. Retrieved 29 August 2015.
  9. 9.0 9.1 9.2 Booker, editors, Carol L. Lake, Peter D. (2005). Pediatric cardiac anesthesia (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 430. ISBN 978-0-7817-5175-9. Retrieved 30 August 2015.CS1 maint: extra text: authors list (link)
  10. "pulmonary Valve disease". Patient.info. EMIS Group. Retrieved 29 August 2015.
  11. Alpert, Joseph (2012). Cardiology and the Primary care Physician (3rd ed.). Current Medicine. p. 306. ISBN 978-1-4615-6603-8. Retrieved 29 August 2015.
  12. O'Connor, Nicholas J. Talley, Simon (2014). Clinical examination : a systematic guide to physical diagnosis (Seventh ed.). Sydney [etc.]: Elsevier, Churchill Livingstone. p. 108. ISBN 978-0-72954-147-3. Retrieved 29 August 2015.
  13. Chaturvedi, Rajiv R; Redington, Andrew N (2007-07-01). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–889. doi:10.1136/hrt.2005.075234. ISSN 1355-6037. PMC 1994453. PMID 17569817.
  14. "Pulmonary Valve Disease. About Pulmonary valve disease | Patient". Patient. Retrieved 2015-08-29.
  15. Auscultation Skills: Breath & Heart Sounds. Lippincott Williams & Wilkins. 2009-10-01. p. 83. ISBN 9781605474540.
  16. "Pulmonic Regurgitation Treatment & Management: Medical Care, Surgical Care, Consultations". 2018-06-28. Cite journal requires |journal= (help)
  17. "Heart valve surgery: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-08-30.

Further reading

External links

Classification
External resources