{{Infobox medical condition (new) | name = Pulmonary valve regurgitation | image = Diagram of the human heart (cropped).svg | caption = Diagram of the human heart | field = Cardiology | pronounce = | synonyms = Pulmonary insufficiency, pulmonary incompetence | symptoms = | complications = | onset = | duration = | types = | causes = Pulmonary hypertension, Infective endocarditis<ref name=booker2005/> | risks = | diagnosis = EKG, Echocardiogram<ref name=pul/> | differential = | prevention = | treatment = Depends on cause<ref name=McGlothlin2006/>(See cause) | medication = | prognosis = | frequency = | deaths = }}
'''Pulmonary''' (or '''pulmonic'''<ref>T. R. Harrison (ed.): ''Principles of Internal Medicine'', Third Edition, McGraw-Hill, New York / Toronto / London 1958, p. 1258.</ref>) '''regurgitation''' (or '''insufficiency''', '''incompetence''') is a condition in which the pulmonary valve is incompetent<ref>{{Cite web |date=2014 |title=Pulmonary Insufficiency |url=http://medical-dictionary.thefreedictionary.com/pulmonary+valve+insufficiency |access-date=29 August 2015 |website=FreeDictionary |publisher=Farlex}}</ref> and allows backflow from the pulmonary artery to the right ventricle of the heart during diastole.<ref>{{Cite book |last1=White |first1=Charles S. |url=https://books.google.com/books?id=bEhYAgAAQBAJ |title=Cardiac Imaging |last2=Haramati |first2=Linda B. |last3=Chen |first3=Joseph Jen-Sho |last4=Levsky |first4=Jeffrey M. |date=2014-03-01 |publisher=OUP USA |isbn=9780199829477 |page=402}}</ref> While a small amount of backflow may occur ordinarily, it is usually only shown on 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.{{medical citation needed|date=August 2015}} If it is secondary to pulmonary hypertension it is referred to as a Graham Steell murmur.<ref>{{Cite book |url=https://books.google.com/books?id=CWr4EEyKZ4wC |title=Auscultation Skills: Breath & Heart Sounds |date=2009-10-01 |publisher=Lippincott Williams & Wilkins |isbn=9781605474540 |page=83}}</ref>
==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.<ref name=McGlothlin2006/> However, more severe regurgitation may contribute to right ventricular enlargement by dilation, and in later stages, right heart failure.<ref name=eMedicine2015/> A diastolic decrescendo murmur can sometimes be identified,( heard best) over the left lower sternal border.{{medical citation needed|date=October 2015}}
==Causes== thumb|Rheumatic heart disease Among the causes of pulmonary insufficiency are:
{{columns-list|colwidth=30em| * Pulmonary hypertension<ref name="booker2005">{{cite book |last1=Booker |first1=Peter D. |url=https://books.google.com/books?id=ymuHmUWuUsAC&q=Pulmonary+hypertension+causes+Pulmonary+insufficiency&pg=PA430 |title=Pediatric cardiac anesthesia |date=2005 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-5175-9 |edition=4th |location=Philadelphia |page=430 |access-date=30 August 2015}}</ref> * Infective endocarditis<ref name=booker2005/> * Rheumatic heart disease<ref name=booker2005/> * Connective tissue disease<ref name="eMedicine2015">{{cite web |title=Pulmonic Regurgitation Clinical Presentation |url=http://emedicine.medscape.com/article/157639-clinical |access-date=29 August 2015 |website=Medscale.com |publisher=eMedicine}}</ref> * Carcinoid syndrome<ref name=eMedicine2015/> * Congenital abnormalities<ref>{{cite web |title=pulmonary Valve disease |url=http://patient.info/doctor/pulmonary-valve-disease |access-date=29 August 2015 |website=Patient.info |publisher=EMIS Group}}</ref> * Tetralogy of Fallot,<ref>{{cite book |last1=Alpert |first1=Joseph |url=https://books.google.com/books?id=x2D1BwAAQBAJ&q=Tetralogy+of+Fallot,+causes+Pulmonary+insufficiency&pg=PA305 |title=Cardiology and the Primary care Physician |date=2012 |publisher=Current Medicine |isbn=978-1-4615-6603-8 |edition=3rd |page=306 |access-date=29 August 2015}}</ref> * Prosthetic heart valve<ref>{{cite book |last1=O'Connor |first1=Nicholas J. Talley, Simon |url=https://books.google.com/books?id=cTFkBgAAQBAJ&q=Prosthetic+heart+valve+causes+Pulmonary+insufficiency&pg=PA108 |title=Clinical examination : a systematic guide to physical diagnosis |date=2014 |publisher=Elsevier, Churchill Livingstone |isbn=978-0-72954-147-3 |edition=Seventh |location=Sydney [etc.] |page=108 |access-date=29 August 2015}}</ref> }}
==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.<ref>{{Cite journal |last1=Chaturvedi |first1=Rajiv R |last2=Redington |first2=Andrew N |date=2007-07-01 |title=Pulmonary regurgitation in congenital heart disease |journal=Heart |volume=93 |issue=7 |pages=880–889 |doi=10.1136/hrt.2005.075234 |issn=1355-6037 |pmc=1994453 |pmid=17569817}}</ref>
==Diagnosis== In the diagnosis of pulmonary regurgitation both echocardiograms and ECG 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.<ref name="pul">{{Cite web |title=Pulmonary Valve Disease. About Pulmonary valve disease {{!}} Patient |url=http://patient.info/doctor/pulmonary-valve-disease |access-date=2015-08-29 |website=Patient}}</ref>
==Treatment== In treating pulmonary regurgitation, 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).<ref>{{cite web |date=14 June 2021 |title=Pulmonary Regurgitation (Pulmonic Regurgitation) Treatment & Management: Approach Considerations, Medical Care, Surgical Care |url=https://emedicine.medscape.com/article/157639-treatment |access-date=12 July 2024 |website=emedicine}}</ref> Furthermore, pulmonary regurgitation is generally treated by addressing the underlying condition,<ref name="McGlothlin2006">{{cite book |last1=McGlothlin |first1=Michael |title=Current consult. |date=2006 |publisher=Lange Medical Books/McGraw-Hill |isbn=978-0-07144-010-3 |location=New York, NY |page=269}}</ref> in certain cases, the pulmonary valve may be surgically replaced.<ref>{{Cite web |title=Heart valve surgery: MedlinePlus Medical Encyclopedia |url=https://www.medlineplus.gov/ency/article/002954.htm |access-date=2015-08-30 |website=www.nlm.nih.gov}}</ref>
==See also== * Pulmonary valve stenosis
==References== {{Reflist}}
==Further reading== * {{Cite book |last1=Lake |first1=Carol L. |url=https://books.google.com/books?id=ymuHmUWuUsAC |title=Pediatric Cardiac Anesthesia |last2=Booker |first2=Peter D. |date=2005-01-01 |publisher=Lippincott Williams & Wilkins |isbn=9780781751759}} * {{Cite journal |last1=Bruce |first1=Charles J. |last2=Connolly |first2=Heidi M. |date=2009-05-26 |title=Right-Sided Valve Disease Deserves a Little More Respect |journal=Circulation |volume=119 |issue=20 |pages=2726–2734 |doi=10.1161/CIRCULATIONAHA.108.776021 |issn=0009-7322 |pmid=19470901 |doi-access=free}} * {{Cite book |last=M.D |first=Steven Lehrer |url=https://books.google.com/books?id=G5Y8TUKfJZYC |title=Understanding Pediatric Heart Sounds |date=2011-12-27 |publisher=Steven Lehrer |isbn=9781468138030}}
== External links == * {{Cite web |title=Problem: Pulmonary Valve Regurgitation |url=http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Problem-Pulmonary-Valve-Regurgitation_UCM_450884_Article.jsp |access-date=2015-08-29 |website=www.heart.org}} {{Medical resources | DiseasesDB = 11014 | ICD10 = {{ICD10|I37}}, {{ICD10|Q22}} | ICD9 = {{ICD9|424.3}}, {{ICD9|746.09}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = med | eMedicineTopic = 1964 | MeshID = D011665 }} {{Commons}}
{{Scholia|topic}} {{Circulatory system pathology}} {{Congenital malformations and deformations of circulatory system}} {{Authority control}}
Category:Valvular heart disease Category:Vascular diseases Category:Medical signs