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Pulmonary Regurgitation (pulmonary insufficiency)

Background:

Over 90 % of the normal population has trivial to mild pulmonary regurgitation (PR) detected by color Doppler echocardiogram. This is what we call physiologic PR and is an incidental finding when the patient is undergoing a color Doppler echocardiogram for other reasons. This type of PR does not need any type of follow-up or intervention, as the pulmonary valve is normal.

There are other cases where the pulmonary valve does not close completely, causing the blood to leak backward from the main pulmonary artery into the right ventricle.

 

Causes:

As mentioned above, a structurally normal pulmonary valve may have a little amount of PR, which is clinically irrelevant. It is found in most normal hearts.

 

In some cases, the pulmonary regurgitation is caused by a malformed or thickened pulmonary valve. It may also be seen in patients with pulmonary stenosis who have undergone balloon valvuloplasty. A small subset of patients with complex heart defects may require a pulmonary conduit (tube), which may start leaking as it gets older. It may also be found in some cases of heart surgery for certain types of congenital heart defects. Finally, it may be seen in patients with pulmonary hypertension (high pressure in the lung vessels).

 

In extremely rare cases, the pulmonary valve may be absent (absent pulmonary valve syndrome). There may be a combination of pulmonary stenosis with severe PR.

 

Pulmonary regurgitation can be caused by infectious diseases such as endocarditis or by carcinoid heart disease, a very rare condition.

 

Symptoms:

Most patients with mild to moderate pulmonary valve regurgitation do not experience any symptoms. They may lead a normal life. Patients with a more severe degree of PR may experience some of these symptoms:

 

Fatigue

Shortness of breath, especially during exertion

Chest pain

Palpitations

Enlarged liver

Fainting with exercise

Exercise intolerance

 

Symptomatic patients undergo further testing and may require surgical intervention.

 

Tests:

An echocardiogram (ECHO) is a painless test that uses ultrasound waves to examine the heart. The echocardiogram is a very sensitive test, which will detect any trivial amount of leakage even in a structurally normal pulmonary valve. This is a very common finding in echocardiogram studies and most cardiologists do not mention it as it may cause unnecessary concern to the parents. There are other heart valves that may have a very small amount of leakage that may be physiologic too.

 

The echocardiogram is very useful detecting the amount of pulmonary regurgitation in cases of “real” leakage. The test also helps to determine the size and function (contractility) of the right ventricle.

 

Patients with severe pulmonary regurgitation may benefit from an MRI. This study will help determine the need and timing of surgery.

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