Pulmonary valve insufficiency
|Pulmonary valve insufficiency|
|Other names: Pulmonary regurgitation, pulmonary incompetence|
|Diagram of the heart with a black arrow showing the location and direction of the abnormal blood flow|
|Symptoms||Few symptoms initially, may develop shortness of breath with exercise|
|Complications||Heart failure, ventricular arrhythmia, tricuspid regurgitation|
|Causes||Pulmonary hypertension, surgical valvulotomy, balloon valvuloplasty, carcinoid disease, infective endocarditis, rheumatic heart disease, congenital valve disease|
|Diagnostic method||Suspected based on a diastolic murmur, confirmed by echocardiogram|
|Differential diagnosis||Aortic regurgitation, pulmonary emboli, constrictive pericarditis|
|Treatment||Active monitoring, pulmonary valve replacement|
|Frequency||Severe disease is rare|
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. Most people have no symptoms. When symptoms do occur these may include shortness of breath with exercise, leg swelling, and an enlarged liver. Complications may include heart failure, ventricular arrhythmia, and tricuspid insufficiency.
Causes may include pulmonary hypertension, surgical valvulotomy, balloon valvuloplasty, carcinoid disease, infective endocarditis, rheumatic heart disease, or congenital valve disease. It commonly occurs in people with tetralogy of Fallot as the surgery to correct the abnormality can result in pulmonary valve issues years later. The diagnosis may be suspected based on a diastolic murmur and confirmed by an ultrasound of the heart.
Yearly ultrasounds may be recommended in those at risk. In those with pulmonary hypertension, that should be treated. In those with symptoms, pulmonary valve replacement may be recommended. The tricuspid valve may benefit from being repaired at the same time. In those unable to have surgery, diuretics, ACE inhibitors, and beta-blockers may be used to treat heart failure. Outcomes can be good with surgery.
Severe pulmonary valve insufficiency is rare. A small to moderate amount of back flow may normally occur. The murmur of pulmonary valve insufficiency was first described in 1873 by George Balfour and later in 1888 by Graham Steell. It was further described by William Osler in 1892, at which time it was considered of little importance.
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. However, more severe regurgitation may contribute to right ventricular enlargement by dilation, and in later stages, right heart failure. A diastolic decrescendo murmur can sometimes be identified,( heard best) over the left lower sternal border.[medical citation needed]
Among the causes of pulmonary insufficiency are:
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.
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.
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). Furthermore, pulmonary insufficiency is generally treated by addressing the underlying condition, in certain cases, the pulmonary valve may be surgically replaced.
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