Pulmonic regurgitation
Pulmonic regurgitation is diastolic backflow from the pulmonary artery into the right ventricle, most often from pulmonary hypertension or after repair of congenital disease such as tetralogy of Fallot. Chronic severe regurgitation causes right ventricular volume overload, and timing of pulmonary valve replacement is guided by right ventricular size and function.
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What this article covers
- Overview
Definition: pulmonic regurgitation is diastolic reflux of blood from the pulmonary artery back into the right ventricle, from valve or annular disease or pulmonary hypertension.
- Epidemiology
Most commonly secondary to pulmonary hypertension.
- Risk factors
Pulmonary hypertension and pulmonary artery dilation.
- Pathophysiology
Right ventricular volume overload: regurgitant flow dilates the right ventricle over time.
- Clinical features
Often asymptomatic for years. Exertional dyspnea, fatigue, and right heart failure with chronic severe disease.
- Differential diagnosis
Aortic regurgitation: a diastolic murmur but left-sided with a wide pulse pressure, distinguished by left rather than right ventricular volume overload (Aortic regurgitation).
- Diagnosis
Establish and grade with echocardiography and quantify right ventricular volumes with cardiac MRI: the diagnostic basis is echocardiography demonstrating diastolic regurgitant flow and its severity…
- Management
First-line, treat the underlying cause when secondary: manage pulmonary hypertension and left heart disease, which reduces the regurgitation driven by high pulmonary pressure.
- Complications
Progressive right ventricular dilation and failure.
- Prognosis
Good when the valve is replaced before irreversible right ventricular dysfunction.
- Prevention
Serial cardiac MRI surveillance every 1 to 2 years after congenital repair to time intervention.
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Related articles
- Pulmonic stenosis
Pulmonic stenosis is obstruction to right ventricular outflow from a narrowed pulmonary valve, usually congenital. It causes a systolic ejection murmur with an ejection click and, when severe, right ventricular hypertrophy and failure; severe or symptomatic disease is treated effectively with balloon valvuloplasty.
- Right heart failure
Right heart failure is inability of the right ventricle to maintain output at acceptable filling pressures, most often from left heart failure or pulmonary hypertension, and acutely from pulmonary embolism or right ventricular infarction. It causes systemic venous congestion, and management centers on the underlying cause, careful volume and afterload optimization, and preload-dependent support in acute disease.
- Aortic regurgitation
Aortic regurgitation is diastolic backflow of blood from the aorta into the left ventricle from valve or aortic root disease. Chronic disease causes volume overload with a wide pulse pressure and a decrescendo diastolic murmur, while acute severe regurgitation is a surgical emergency; severe symptomatic or decompensating disease is treated with valve replacement.
- Tricuspid regurgitation
Tricuspid regurgitation is systolic backflow from the right ventricle into the right atrium, most often secondary (functional) from right ventricular or annular dilation and pulmonary hypertension. It causes right-sided congestion with a prominent jugular v wave and a systolic murmur that increases on inspiration; management targets the underlying cause and, in selected severe disease, valve intervention.
- Patent ductus arteriosus
Patent ductus arteriosus is persistence of the fetal ductus connecting the aorta and pulmonary artery, causing a continuous machinery murmur and a left-to-right shunt. In preterm infants it is treated with prostaglandin inhibitors; in others it is closed by transcatheter device or surgery, before pulmonary vascular disease develops.