Pulmonic regurgitation

Pulmonic regurgitation, also known as pulmonary regurgitation, is the backward flow of blood from the pulmonary artery, through the pulmonary valve, and into the right ventricle of the heart during diastole. While a small amount of pulmonic regurgitation may occur in healthy individuals, it is usually detectable only by an echocardiogram and is harmless. More pronounced regurgitation that is noticed through a routine physical examination is a medical sign of disease and warrants further investigation.

Signs and symptoms

Mild cases usually do not cause any 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 dilation/enlargement, and in later stages, right heart failure.

A decrescendo murmur can sometimes be identified early in diastole, heard best over the left lower sternal border.

Causes

• Pulmonary hypertension
• Infective endocarditis
• Rheumatic heart disease
• Congenital absence of the pulmonary valve
• Carcinoid syndrome
• Congestive abnormalities
• Tetralogy of Fallot, a malformation of the heart characterized by four co-occurring defects: a ventricular septal defect, a misplaced origin of the aorta causing it to override the septal defect, narrowing of the pulmonary artery, and enlargement of the right ventricle.
• Iatrogenic (post surgical repair for congenital heart disease)
• Chest trauma
• Carcinoid heart disease (tumor)
• Prosthetic heart valve dysfunction

Treatment

Asymptomatic cases do not require treatment.

Pulmonic regurgitation is generally treated by addressing the underlying condition. In certain cases, the pulmonary valve may be surgically replaced.

References

• Lange 2008 Current Medical Diagnosis and Treatment, 47th edition pp. 298–299 ISBN 978-0071494304.
• Xiushui, R., Saavedra, P., Cannistra, L. "Pulmonic Regurgitation", eMedicine, http://www.emedicine.com/med/topic1964.htm