Pulmonic regurgitation causes: Difference between revisions

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(/* Causes by Organ System{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the A...)
 
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{{Pulmonic regurgitation}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Pulmonic_regurgitation]]


{{CMG}}; {{AE}} {{M.P}} {{AKI}}, {{AA}}
{{CMG}}; {{AE}} {{M.P}} {{AKI}}, {{AA}}, {{JA}}


==Overview==
==Overview==
A small percentage of [[pulmonic regurgitation]] is normal and occasionally murmur can be heard in thin subjects. The most common causes of [[pulmonary regurgitation]] are following repair of [[tetralogy of Fallot]] and [[pulmonary stenosis]].
[[Pulmonic regurgitation]] may be normal (physiologic) and occasionally a [[murmur]] can be heard among thin subjects. Life-threatening cause of [[PR]] include chest [[trauma]]. The most common causes of [[pulmonary regurgitation]] are following the repair of [[tetralogy of Fallot]] and [[pulmonary stenosis]]. [[PR]] is also common among [[patients]] with [[pulmonary hypertension]] (PAH). [[Rheumatic heart disease]] is also an uncommon cause and is more commonly observed in developing countries. The primary causes of [[PR]] include an intrinsic [[pathology]] in the [[pulmonic valve]] and secondary causes include extrinsic causes. The causes of [[pulmonic regurgitation]] may also be reckoned on the basis of the organ systems involved.


==Causes==
==Causes==
===Life-threatening causes===
*Life-threatening causes of [[PR]] include chest [[trauma]].
===Common causes===
*Secondary [[PR]] is more common than primary [[PR]].<ref>{{cite book | last = Fauci | first = Anthony | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Medical | location = New York | year = 2008 | isbn = 978-0071466332 }}</ref>
*[[PR|Pulmonic regurgitation]] (PR) is most common after [[TOF]] or [[pulmonary stenosis]] repair .<ref name="WarnesWilliams2008">{{cite journal|last1=Warnes|first1=Carole A.|last2=Williams|first2=Roberta G.|last3=Bashore|first3=Thomas M.|last4=Child|first4=John S.|last5=Connolly|first5=Heidi M.|last6=Dearani|first6=Joseph A.|last7=del Nido|first7=Pedro|last8=Fasules|first8=James W.|last9=Graham|first9=Thomas P.|last10=Hijazi|first10=Ziyad M.|last11=Hunt|first11=Sharon A.|last12=King|first12=Mary Etta|last13=Landzberg|first13=Michael J.|last14=Miner|first14=Pamela D.|last15=Radford|first15=Martha J.|last16=Walsh|first16=Edward P.|last17=Webb|first17=Gary D.|title=ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary|journal=Circulation|volume=118|issue=23|year=2008|pages=2395–2451|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.108.190811}}</ref><ref name="WeinbergMcElhinney2014">{{cite journal|last1=Weinberg|first1=Catherine R.|last2=McElhinney|first2=Doff B.|title=Pulmonary Valve Replacement in Tetralogy of Fallot|journal=Circulation|volume=130|issue=9|year=2014|pages=795–798|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.114.005551}}</ref>
*[[PR]] is also common among [[patients]] with [[pulmonary hypertension]] (PAH).<ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref>
===Less common causes===
*[[Carcinoid syndrome|Carcinoid heart disease]], [[infective endocarditis]], [[tertiary syphilis]], and [[connective tissue disorders]] are uncommon causes of [[PR]].<ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref>
*[[Rheumatic heart disease]] is also an uncommon cause and is more commonly observed in developing countries.
*[[Idiopathic]] dilatation of [[pulmonary artery]] is a rare cause of [[PR]].<ref name="pmid27891002">{{cite journal |vauthors=Sharma RK, Talwar D, Gupta SK, Bansal S |title=Idiopathic dilatation of pulmonary artery |journal=Lung India |volume=33 |issue=6 |pages=675–677 |date=2016 |pmid=27891002 |pmc=5112830 |doi=10.4103/0970-2113.192869 |url=}}</ref><ref name="pmid28228295">{{cite journal |vauthors=Malviya A, Jha PK, Kalita JP, Saikia MK, Mishra A |title=Idiopathic dilatation of pulmonary artery: A review |journal=Indian Heart J |volume=69 |issue=1 |pages=119–124 |date=2017 |pmid=28228295 |pmc=5319124 |doi=10.1016/j.ihj.2016.07.009 |url=}}</ref>
*[[Pulmonary artery]] aneurysm is not a common cause of [[PR]] but the [[aneurysm]] itself is most commonly caused by [[congenital]] defects and secondly [[tertiary syphilis]]. [[Atherosclerosis|Atherosclerotic]], [[degenerative]], and [[trauma|traumatic]] causes are also included.<ref name="pmid16181901">{{cite journal |vauthors=Deb SJ, Zehr KJ, Shields RC |title=Idiopathic pulmonary artery aneurysm |journal=Ann. Thorac. Surg. |volume=80 |issue=4 |pages=1500–2 |date=October 2005 |pmid=16181901 |doi=10.1016/j.athoracsur.2004.04.011 |url=}}</ref><ref name="pmid26539456">{{cite journal |vauthors=Xie D, Chen C, Wang H, Xu Z, Jiang G |title=Refractory pulmonary artery aneurysm in Behçet's disease |journal=Ann Transl Med |volume=3 |issue=16 |pages=239 |date=September 2015 |pmid=26539456 |pmc=4598455 |doi=10.3978/j.issn.2305-5839.2015.09.27 |url=}}</ref>
*[[Takayasu arteritis]] is a rare cause of [[PAH]] and may cause [[PR]].<ref name="YangPeng2019">{{cite journal|last1=Yang|first1=Jing|last2=Peng|first2=Min|last3=Shi|first3=Juhong|last4=Zheng|first4=Wenjie|last5=Yu|first5=Xuezhong|title=Pulmonary artery involvement in Takayasu’s arteritis: diagnosis before pulmonary hypertension|journal=BMC Pulmonary Medicine|volume=19|issue=1|year=2019|issn=1471-2466|doi=10.1186/s12890-019-0983-7}}</ref>
===Causes by etiology===
*[[PR]] may be physiologic or pathologic. Pathologic causes may be divided among primary and secondary. Isolated PR is very rare and is most commonly associated with other [[congenital heart diseases]].<ref name="pmid17569817">{{cite journal| author=Chaturvedi RR, Redington AN| title=Pulmonary regurgitation in congenital heart disease. | journal=Heart | year= 2007 | volume= 93 | issue= 7 | pages= 880-9 | pmid=17569817 | doi=10.1136/hrt.2005.075234 | pmc=1994453 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17569817  }} </ref>  The following flow chart demonstrates the causes of [[PR]] based upon the [[etiology]].<br>
<br>


{{familytree/start}}
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{{familytree | | | | | | | | | | | | | A01 | | | | | |A01='''Causes of Pulmonic regurgitation''' (PR)}}
{{familytree | | | | | | | | | | | | | A01 | | | | | |A01='''Causes of [[Pulmonic regurgitation]]''' (PR)}}
{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| }}
{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| }}
{{familytree | | | | | | B01 | | | | | B02 | | | | B03 |B01='''Physiologic'''<br>Mostly found in healthy young people on [[Doppler echocardiography|doppler echo]]<ref name="pmid8304596">{{cite journal |vauthors=Macchi C, Orlandini SZ, Orlandini GE |title=An anatomical study of the healthy human heart by echocardiography with special reference to physiological valvular regurgitation |journal=Ann. Anat. |volume=176 |issue=1 |pages=81–6 |date=January 1994 |pmid=8304596 |doi=10.1016/s0940-9602(11)80421-8 |url=}}</ref><ref name="pmid2637102">{{cite journal |vauthors=Král J, Hradec J, Petrásek J |title=Valvular regurgitations in healthy young people |journal=Cor Vasa |volume=31 |issue=6 |pages=485–94 |date=1989 |pmid=2637102 |doi= |url=}}</ref><ref name="pmid1760180">{{cite journal |vauthors=Maciel BC, Simpson IA, Valdes-Cruz LM, Recusani F, Hoit B, Dalton N, Weintraub R, Sahn DJ |title=Color flow Doppler mapping studies of "physiologic" pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume |journal=J Am Soc Echocardiogr |volume=4 |issue=6 |pages=589–97 |date=1991 |pmid=1760180 |doi=10.1016/s0894-7317(14)80218-6 |url=}}</ref>|B02='''Primary'''<ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref>|B03='''Secondary'''<ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref>}}
{{familytree | | | | | | B01 | | | | | B02 | | | | B03 |B01='''Physiologic'''<ref name="pmid8304596">{{cite journal |vauthors=Macchi C, Orlandini SZ, Orlandini GE |title=An anatomical study of the healthy human heart by echocardiography with special reference to physiological valvular regurgitation |journal=Ann. Anat. |volume=176 |issue=1 |pages=81–6 |date=January 1994 |pmid=8304596 |doi=10.1016/s0940-9602(11)80421-8 |url=}}</ref><ref name="pmid2637102">{{cite journal |vauthors=Král J, Hradec J, Petrásek J |title=Valvular regurgitations in healthy young people |journal=Cor Vasa |volume=31 |issue=6 |pages=485–94 |date=1989 |pmid=2637102 |doi= |url=}}</ref><ref name="pmid1760180">{{cite journal |vauthors=Maciel BC, Simpson IA, Valdes-Cruz LM, Recusani F, Hoit B, Dalton N, Weintraub R, Sahn DJ |title=Color flow Doppler mapping studies of "physiologic" pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume |journal=J Am Soc Echocardiogr |volume=4 |issue=6 |pages=589–97 |date=1991 |pmid=1760180 |doi=10.1016/s0894-7317(14)80218-6 |url=}}</ref><br>Mostly found among healthy young people on [[Doppler echocardiography|doppler echo]]|B02='''Primary'''<ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref>|B03='''Secondary'''<ref name="LancellottiTribouilloy2010">{{cite journal|last1=Lancellotti|first1=P.|last2=Tribouilloy|first2=C.|last3=Hagendorff|first3=A.|last4=Moura|first4=L.|last5=Popescu|first5=B. A.|last6=Agricola|first6=E.|last7=Monin|first7=J. L.|last8=Pierard|first8=L. A.|last9=Badano|first9=L.|last10=Zamorano|first10=J. L.|last11=Sicari|first11=R.|last12=Vahanian|first12=A.|last13=Roelandt|first13=J. R. T. C.|title=European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)|journal=European Journal of Echocardiography|volume=11|issue=3|year=2010|pages=223–244|issn=1525-2167|doi=10.1093/ejechocard/jeq030}}</ref><ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref><ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref><ref name="pmid28053559">{{cite journal |vauthors=Tselios K, Gladman DD, Urowitz MB |title=Systemic lupus erythematosus and pulmonary arterial hypertension: links, risks, and management strategies |journal=Open Access Rheumatol |volume=9 |issue= |pages=1–9 |date=2017 |pmid=28053559 |pmc=5191623 |doi=10.2147/OARRR.S123549 |url=}}</ref><ref name="pmid16181901">{{cite journal |vauthors=Deb SJ, Zehr KJ, Shields RC |title=Idiopathic pulmonary artery aneurysm |journal=Ann. Thorac. Surg. |volume=80 |issue=4 |pages=1500–2 |date=October 2005 |pmid=16181901 |doi=10.1016/j.athoracsur.2004.04.011 |url=}}</ref><ref name="pmid26539456">{{cite journal |vauthors=Xie D, Chen C, Wang H, Xu Z, Jiang G |title=Refractory pulmonary artery aneurysm in Behçet's disease |journal=Ann Transl Med |volume=3 |issue=16 |pages=239 |date=September 2015 |pmid=26539456 |pmc=4598455 |doi=10.3978/j.issn.2305-5839.2015.09.27 |url=}}</ref><ref name="pmid11997425">{{cite journal |vauthors=Nollen GJ, van Schijndel KE, Timmermans J, Groenink M, Barentsz JO, van der Wall EE, Stoker J, Mulder BJ |title=Pulmonary artery root dilatation in Marfan syndrome: quantitative assessment of an unknown criterion |journal=Heart |volume=87 |issue=5 |pages=470–1 |date=May 2002 |pmid=11997425 |pmc=1767105 |doi=10.1136/heart.87.5.470 |url=}}</ref> }}
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{{familytree | | | | | | | | | | | | | |!| | |E01| | | | E02|E01=•[[Pulmonary artery]] dilation<br>•Right [[ventricle|ventricular]] outlet [[aneurysm]]|E02=•[[Pulmonary hypertension]]}}
{{familytree | | | | | | | | | | | | | |!| | |E01| | | | E02|E01=•[[Pulmonary artery]] dilation/<br> right [[ventricle|ventricular]] outlet [[aneurysm]]<br> (congenital, [[tertiary syphilis]],<br> [[Behçet disease]], or [[Marfan syndrome]]}|E02=•[[Pulmonary hypertension]]<br> ([[SLE]] can be a cause)}}
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{{familytree | | | | | | | | | |F01| | | | F02 | |F01='''Acquired'''|F02='''Congenital'''<br>•Quadricuspid or [[Bicuspid valve]]s<br>•[[Valve|Valvular]] [[hypoplasia]]<br>•[[pulmonary valve]][[Prolapse]]<br>•[[Absent pulmonary valve]]<br>•Isolated congenital PR<br>•[[Ebstein’s anomaly]] (acute PR)<br>•[[Right ventricular outflow tract obstruction pulmonary supravalvular stenosis|Peripheral pulmonary artery stenosis]]}}
{{familytree | | | | | | | | | |F01| | | | F02 | |F01='''Acquired'''|F02='''[[Congenital]]'''<ref name="LancellottiTribouilloy2010">{{cite journal|last1=Lancellotti|first1=P.|last2=Tribouilloy|first2=C.|last3=Hagendorff|first3=A.|last4=Moura|first4=L.|last5=Popescu|first5=B. A.|last6=Agricola|first6=E.|last7=Monin|first7=J. L.|last8=Pierard|first8=L. A.|last9=Badano|first9=L.|last10=Zamorano|first10=J. L.|last11=Sicari|first11=R.|last12=Vahanian|first12=A.|last13=Roelandt|first13=J. R. T. C.|title=European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)|journal=European Journal of Echocardiography|volume=11|issue=3|year=2010|pages=223–244|issn=1525-2167|doi=10.1093/ejechocard/jeq030}}</ref><br>•Quadricuspid or [[Bicuspid valve]]s<br>•[[Valve|Valvular]] [[hypoplasia]]<br>•[[pulmonary valve]] [[prolapse]]<br>•[[Absent pulmonary valve]]<br>•Isolated [[congenital]] PR<br>•[[Ebstein’s anomaly]] ([[acute]] PR)<br>•[[Right ventricular outflow tract obstruction pulmonary supravalvular stenosis|Peripheral pulmonary artery stenosis]]}}
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{{familytree | | |!| | | |!| | | | | | |!| | | |!| }}
{{familytree | | C01 | | C02 | | | | | C03 | | C04 | |C01='''Trauma''' (usually life-threatening) <br>•[[chest trauma|Blunt or penetrating chest trauma]]<br>•[[Myocardial rupture]]<br>|C02='''Infectious'''/'''Immune-related'''<br>•[[Infective endocarditis]] (can be life-threatening)<br>•[[Rheumatic heart disease]]<br>|C03='''Tumor'''/'''Genetic causes'''<br>•[[Carcinoid syndrome|Carconoid heart disease]]<ref name="pmid15367531">{{cite journal |vauthors=Fox DJ, Khattar RS |title=Carcinoid heart disease: presentation, diagnosis, and management |journal=Heart |volume=90 |issue=10 |pages=1224–8 |date=October 2004 |pmid=15367531 |pmc=1768473 |doi=10.1136/hrt.2004.040329 |url=}}</ref><br>•[[Myxomatous degeneration]] of the [[pulmonary valve]]<br>|C04='''Iatrogenic'''<ref name="pmid11436049">{{cite journal| author=Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P et al.| title=Long-term results after early primary repair of tetralogy of Fallot. | journal=J Thorac Cardiovasc Surg | year= 2001 | volume= 122 | issue= 1 | pages= 154-61 | pmid=11436049 | doi=10.1067/mtc.2001.115156 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11436049  }}</ref><ref name="pmid26656195">{{cite journal| author=Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS| title=Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). | journal=J Thorac Imaging | year= 2016 | volume= 31 | issue= 1 | pages= W4-12 | pmid=26656195 | doi=10.1097/RTI.0000000000000182 | pmc= |url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26656195  }} </ref><ref name="pmid26564602">{{cite journal| author=Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D et al.| title=Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future. | journal=J Am Coll Cardiol | year= 2015 | volume= 66 | issue= 20 | pages= 2246-55 | pmid=26564602 | doi=10.1016/j.jacc.2015.09.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26564602  }} </ref><br>•Post [[Pulmonary valve stenosis|pulmonary valve  stenosis]] repair<br>• Post [[Tetralogy of Fallot|TOF]] transannular patch repair<br>•Post [[Blalock-Taussig shunt]] [[Tetralogy of Fallot|TOF]] repair<br>•Post balloon or surgical valvulotomy or [[valvuloplasty]] for [[pulmonary stenosis]] (acute PR)<br>•Perforation of valvular [[pulmonary atresia]] (acute PR)<br>•Medications acting via [[serotonin|serotonergic pathways]] such as ergot derivatives (Pergolide)<ref name="CorvolAnzouan-Kacou2007">{{cite journal|last1=Corvol|first1=Jean-Christophe|last2=Anzouan-Kacou|first2=Jean-Baptiste|last3=Fauveau|first3=Elodie|last4=Bonnet|first4=Anne-Marie|last5=Lebrun-Vignes|first5=Bénédicte|last6=Girault|first6=Camille|last7=Agid|first7=Yves|last8=Lechat|first8=Philippe|last9=Isnard|first9=Richard|last10=Lacomblez|first10=Lucette|title=Heart Valve Regurgitation, Pergolide Use, and Parkinson Disease|journal=Archives of Neurology|volume=64|issue=12|year=2007|pages=1721|issn=0003-9942|doi=10.1001/archneur.64.12.1721}}</ref><ref name="pmid19553085">{{cite journal |vauthors=Smith SA, Waggoner AD, de las Fuentes L, Davila-Roman VG |title=Role of serotoninergic pathways in drug-induced valvular heart disease and diagnostic features by echocardiography |journal=J Am Soc Echocardiogr |volume=22 |issue=8 |pages=883–9 |date=August 2009 |pmid=19553085 |pmc=3808845 |doi=10.1016/j.echo.2009.05.002 |url=}}</ref>}}
{{familytree | | C01 | | C02 | | | | | C03 | | C04 | |C01='''[[Trauma]]''' (usually life-threatening)<ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref> <br>•[[chest trauma|Blunt or penetrating chest trauma]]<br>•[[Myocardial rupture]]<br>|C02='''Infectious'''/'''Immune-related'''<ref name="LancellottiTribouilloy2010">{{cite journal|last1=Lancellotti|first1=P.|last2=Tribouilloy|first2=C.|last3=Hagendorff|first3=A.|last4=Moura|first4=L.|last5=Popescu|first5=B. A.|last6=Agricola|first6=E.|last7=Monin|first7=J. L.|last8=Pierard|first8=L. A.|last9=Badano|first9=L.|last10=Zamorano|first10=J. L.|last11=Sicari|first11=R.|last12=Vahanian|first12=A.|last13=Roelandt|first13=J. R. T. C.|title=European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)|journal=European Journal of Echocardiography|volume=11|issue=3|year=2010|pages=223–244|issn=1525-2167|doi=10.1093/ejechocard/jeq030}}</ref><br>•[[Infective endocarditis]] (can be life-threatening)<br>•[[Rheumatic heart disease]]<br>|C03='''Tumor'''/'''Genetic causes'''<ref name="LancellottiTribouilloy2010">{{cite journal|last1=Lancellotti|first1=P.|last2=Tribouilloy|first2=C.|last3=Hagendorff|first3=A.|last4=Moura|first4=L.|last5=Popescu|first5=B. A.|last6=Agricola|first6=E.|last7=Monin|first7=J. L.|last8=Pierard|first8=L. A.|last9=Badano|first9=L.|last10=Zamorano|first10=J. L.|last11=Sicari|first11=R.|last12=Vahanian|first12=A.|last13=Roelandt|first13=J. R. T. C.|title=European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)|journal=European Journal of Echocardiography|volume=11|issue=3|year=2010|pages=223–244|issn=1525-2167|doi=10.1093/ejechocard/jeq030}}</ref><ref name="pmid15367531">{{cite journal |vauthors=Fox DJ, Khattar RS |title=Carcinoid heart disease: presentation, diagnosis, and management |journal=Heart |volume=90 |issue=10 |pages=1224–8 |date=October 2004 |pmid=15367531 |pmc=1768473 |doi=10.1136/hrt.2004.040329 |url=}}</ref><br>•[[Carcinoid syndrome|Carconoid heart disease]]<br>•[[Myxomatous degeneration]] of the [[pulmonary valve]]<br>|C04='''Iatrogenic'''<ref name="LancellottiTribouilloy2010">{{cite journal|last1=Lancellotti|first1=P.|last2=Tribouilloy|first2=C.|last3=Hagendorff|first3=A.|last4=Moura|first4=L.|last5=Popescu|first5=B. A.|last6=Agricola|first6=E.|last7=Monin|first7=J. L.|last8=Pierard|first8=L. A.|last9=Badano|first9=L.|last10=Zamorano|first10=J. L.|last11=Sicari|first11=R.|last12=Vahanian|first12=A.|last13=Roelandt|first13=J. R. T. C.|title=European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)|journal=European Journal of Echocardiography|volume=11|issue=3|year=2010|pages=223–244|issn=1525-2167|doi=10.1093/ejechocard/jeq030}}</ref><ref name="pmid11436049">{{cite journal| author=Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P et al.| title=Long-term results after early primary repair of tetralogy of Fallot. | journal=J Thorac Cardiovasc Surg | year= 2001 | volume= 122 | issue= 1 | pages= 154-61 | pmid=11436049 | doi=10.1067/mtc.2001.115156 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11436049  }}</ref><ref name="pmid26656195">{{cite journal| author=Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS| title=Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). | journal=J Thorac Imaging | year= 2016 | volume= 31 | issue= 1 | pages= W4-12 | pmid=26656195 | doi=10.1097/RTI.0000000000000182 | pmc= |url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26656195  }} </ref><ref name="pmid26564602">{{cite journal| author=Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D et al.| title=Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future. | journal=J Am Coll Cardiol | year= 2015 | volume= 66 | issue= 20 | pages= 2246-55 | pmid=26564602 | doi=10.1016/j.jacc.2015.09.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26564602  }} </ref><br>•Post [[Pulmonary valve stenosis|pulmonary valve  stenosis]] repair<br>• Post [[Tetralogy of Fallot|TOF]] transannular patch repair<br>•Post [[Blalock-Taussig shunt]] [[Tetralogy of Fallot|TOF]] repair<br>•Post balloon or surgical valvulotomy or [[valvuloplasty]] for [[pulmonary stenosis]] (acute PR)<br>•Perforation of valvular [[pulmonary atresia]] ([[acute]] PR)<br>•[[Medication|Medications]] acting via [[serotonin|serotonergic pathways]] such as [[ergot]] derivatives ([[Pergolide]])<ref name="CorvolAnzouan-Kacou2007">{{cite journal|last1=Corvol|first1=Jean-Christophe|last2=Anzouan-Kacou|first2=Jean-Baptiste|last3=Fauveau|first3=Elodie|last4=Bonnet|first4=Anne-Marie|last5=Lebrun-Vignes|first5=Bénédicte|last6=Girault|first6=Camille|last7=Agid|first7=Yves|last8=Lechat|first8=Philippe|last9=Isnard|first9=Richard|last10=Lacomblez|first10=Lucette|title=Heart Valve Regurgitation, Pergolide Use, and Parkinson Disease|journal=Archives of Neurology|volume=64|issue=12|year=2007|pages=1721|issn=0003-9942|doi=10.1001/archneur.64.12.1721}}</ref><ref name="pmid19553085">{{cite journal |vauthors=Smith SA, Waggoner AD, de las Fuentes L, Davila-Roman VG |title=Role of serotoninergic pathways in drug-induced valvular heart disease and diagnostic features by echocardiography |journal=J Am Soc Echocardiogr |volume=22 |issue=8 |pages=883–9 |date=August 2009 |pmid=19553085 |pmc=3808845 |doi=10.1016/j.echo.2009.05.002 |url=}}</ref>}}
{{familytree/end}}
{{familytree/end}}<br>


===Causes by Organ System<ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref><ref name="pmid15367531">{{cite journal |vauthors=Fox DJ, Khattar RS |title=Carcinoid heart disease: presentation, diagnosis, and management |journal=Heart |volume=90 |issue=10 |pages=1224–8 |date=October 2004 |pmid=15367531 |pmc=1768473 |doi=10.1136/hrt.2004.040329 |url=}}</ref><ref name="pmid11436049">{{cite journal| author=Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P et al.| title=Long-term results after early primary repair of tetralogy of Fallot. | journal=J Thorac Cardiovasc Surg | year= 2001 | volume= 122 | issue= 1 | pages= 154-61 | pmid=11436049 | doi=10.1067/mtc.2001.115156 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11436049  }}</ref><ref name="pmid26656195">{{cite journal| author=Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS| title=Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). | journal=J Thorac Imaging | year= 2016 | volume= 31 | issue= 1 | pages= W4-12 | pmid=26656195 | doi=10.1097/RTI.0000000000000182 | pmc= |url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26656195  }} </ref><ref name="pmid26564602">{{cite journal| author=Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D et al.| title=Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future. | journal=J Am Coll Cardiol | year= 2015 | volume= 66 | issue= 20 | pages= 2246-55 | pmid=26564602 | doi=10.1016/j.jacc.2015.09.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26564602  }} </ref><ref name="CurtissMiller1983">{{cite journal|last1=Curtiss|first1=E I|last2=Miller|first2=T R|last3=Shapiro|first3=L S|title=Pulmonic regurgitation due to valvular tophi.|journal=Circulation|volume=67|issue=3|year=1983|pages=699–701|issn=0009-7322|doi=10.1161/01.CIR.67.3.699}}</ref>===
===Causes by Organ System<ref name="pmid18997168">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). | journal=Circulation | year= 2008 | volume= 118 | issue= 23 | pages= 2395-451 | pmid=18997168 | doi=10.1161/CIRCULATIONAHA.108.190811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997168  }} </ref><ref name="pmid15367531">{{cite journal |vauthors=Fox DJ, Khattar RS |title=Carcinoid heart disease: presentation, diagnosis, and management |journal=Heart |volume=90 |issue=10 |pages=1224–8 |date=October 2004 |pmid=15367531 |pmc=1768473 |doi=10.1136/hrt.2004.040329 |url=}}</ref><ref name="pmid11436049">{{cite journal| author=Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P et al.| title=Long-term results after early primary repair of tetralogy of Fallot. | journal=J Thorac Cardiovasc Surg | year= 2001 | volume= 122 | issue= 1 | pages= 154-61 | pmid=11436049 | doi=10.1067/mtc.2001.115156 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11436049  }}</ref><ref name="pmid26656195">{{cite journal| author=Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS| title=Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). | journal=J Thorac Imaging | year= 2016 | volume= 31 | issue= 1 | pages= W4-12 | pmid=26656195 | doi=10.1097/RTI.0000000000000182 | pmc= |url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26656195  }} </ref><ref name="pmid26564602">{{cite journal| author=Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D et al.| title=Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future. | journal=J Am Coll Cardiol | year= 2015 | volume= 66 | issue= 20 | pages= 2246-55 | pmid=26564602 | doi=10.1016/j.jacc.2015.09.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26564602  }} </ref><ref name="CurtissMiller1983">{{cite journal|last1=Curtiss|first1=E I|last2=Miller|first2=T R|last3=Shapiro|first3=L S|title=Pulmonic regurgitation due to valvular tophi.|journal=Circulation|volume=67|issue=3|year=1983|pages=699–701|issn=0009-7322|doi=10.1161/01.CIR.67.3.699}}</ref><ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref><ref name="pmid11997425">{{cite journal |vauthors=Nollen GJ, van Schijndel KE, Timmermans J, Groenink M, Barentsz JO, van der Wall EE, Stoker J, Mulder BJ |title=Pulmonary artery root dilatation in Marfan syndrome: quantitative assessment of an unknown criterion |journal=Heart |volume=87 |issue=5 |pages=470–1 |date=May 2002 |pmid=11997425 |pmc=1767105 |doi=10.1136/heart.87.5.470 |url=}}</ref><ref name="YangPeng2019">{{cite journal|last1=Yang|first1=Jing|last2=Peng|first2=Min|last3=Shi|first3=Juhong|last4=Zheng|first4=Wenjie|last5=Yu|first5=Xuezhong|title=Pulmonary artery involvement in Takayasu’s arteritis: diagnosis before pulmonary hypertension|journal=BMC Pulmonary Medicine|volume=19|issue=1|year=2019|issn=1471-2466|doi=10.1186/s12890-019-0983-7}}</ref>===
<br>


{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Congenital heart disease]], [[dilated cardiomyopathy]], [[Eisenmenger syndrome]], [[endocarditis]], [[infective endocarditis]], [[myocardial rupture]], [[patent ductus arteriosus]], [[rheumatic heart disease]], [[cardiac tumors|right ventricular tumors]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Congenital heart disease]], [[dilated cardiomyopathy]], [[Eisenmenger syndrome]], [[endocarditis]], [[infective endocarditis]], [[myocardial rupture]], [[patent ductus arteriosus]], [[rheumatic heart disease]], [[cardiac tumors|right ventricular tumors]], [[myxomatous degeneration]] of the [[pulmonary valve]], and [[Takayasu arteritis]]
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
Line 67: Line 85:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[Mucopolysaccharidoses]], [[patent ductus arteriosus]], [[polycystic kidney disease]], [[dilated cardiomyopathy|X-linked dilated cardiomyopathy]]
|bgcolor="Beige"| [[Mucopolysaccharidoses]], [[patent ductus arteriosus]], [[polycystic kidney disease]], [[dilated cardiomyopathy|X-linked dilated cardiomyopathy]], [[Marfan syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 79: Line 97:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Infective endocarditis]], [[myocarditis]], [[rheumatic fever]]
|bgcolor="Beige"| [[Infective endocarditis]], [[myocarditis]], [[rheumatic fever]], [[tertiary syphilis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 123: Line 141:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Rheumatic fever]], [[sarcoidosis]]
|bgcolor="Beige"| [[Rheumatic fever]], [[sarcoidosis]], [[Behçet disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 139: Line 157:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[SLE]]
|-
|-
|}
|}
<br>


===Causes in Alphabetical Order===
===Causes in alphabetical order===
{{col-begin|width=80%}}
{{col-begin|width=80%}}
{{col-break|width=33%}}
{{col-break|width=33%}}
*[[balloon valvuloplasty|Balloon valvuloplasty of the pulmonary valve]]
*[[balloon valvuloplasty|Balloon valvuloplasty of the pulmonary valve]]
*[[Behçet disease]]<ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref>
*[[chest trauma|Blunt or penetrating chest trauma]]
*[[chest trauma|Blunt or penetrating chest trauma]]
*[[Cabergoline]]<ref name="pmid19683643">{{cite journal| author=Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J| title=Drug-induced fibrotic valvular heart disease. | journal=Lancet | year= 2009 | volume= 374 | issue= 9689 | pages= 577-85 | pmid=19683643 | doi=10.1016/S0140-6736(09)60252-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19683643 }} </ref>
*[[Cabergoline]]<ref name="pmid19683643">{{cite journal| author=Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J| title=Drug-induced fibrotic valvular heart disease. | journal=Lancet | year= 2009 | volume= 374 | issue= 9689 | pages= 577-85 | pmid=19683643 | doi=10.1016/S0140-6736(09)60252-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19683643 }} </ref>
Line 171: Line 191:
*[[Myocardial rupture]]
*[[Myocardial rupture]]
*[[Myocarditis]]
*[[Myocarditis]]
*[[Myxomatous degeneration]] of the [[pulmonary valve]]
*[[Pacemaker syndrome]]
*[[Pacemaker syndrome]]
*[[Paroxetine]]
*[[Paroxetine]]
Line 187: Line 208:
*[[cardiac tumors|Right ventricular tumors]]
*[[cardiac tumors|Right ventricular tumors]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
*[[SLE]]<ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref>
*[[Tertiary syphilis]]<ref name="SaremiGera2014">{{cite journal|last1=Saremi|first1=Farhood|last2=Gera|first2=Atul|last3=Yen Ho|first3=S.|last4=Hijazi|first4=Ziyad M.|last5=Sánchez-Quintana|first5=Damián|title=CT and MR Imaging of the Pulmonary Valve|journal=RadioGraphics|volume=34|issue=1|year=2014|pages=51–71|issn=0271-5333|doi=10.1148/rg.341135026}}</ref>
*[[Blalock-Taussig shunt|Tetralogy of Fallot repair]]<ref name="pmid15028368">{{cite journal| author=Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ| title=Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. | journal=J Am Coll Cardiol | year= 2004 | volume= 43 | issue= 6 | pages= 1068-74 | pmid=15028368 | doi=10.1016/j.jacc.2003.10.045 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028368 }} </ref>
*[[Blalock-Taussig shunt|Tetralogy of Fallot repair]]<ref name="pmid15028368">{{cite journal| author=Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ| title=Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. | journal=J Am Coll Cardiol | year= 2004 | volume= 43 | issue= 6 | pages= 1068-74 | pmid=15028368 | doi=10.1016/j.jacc.2003.10.045 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15028368 }} </ref>
{{col-end}}
{{col-end}}

Latest revision as of 16:40, 4 August 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Aravind Kuchkuntla, M.B.B.S[3], Aysha Anwar, M.B.B.S[4], Javaria Anwer M.D.[5]

Overview

Pulmonic regurgitation may be normal (physiologic) and occasionally a murmur can be heard among thin subjects. Life-threatening cause of PR include chest trauma. The most common causes of pulmonary regurgitation are following the repair of tetralogy of Fallot and pulmonary stenosis. PR is also common among patients with pulmonary hypertension (PAH). Rheumatic heart disease is also an uncommon cause and is more commonly observed in developing countries. The primary causes of PR include an intrinsic pathology in the pulmonic valve and secondary causes include extrinsic causes. The causes of pulmonic regurgitation may also be reckoned on the basis of the organ systems involved.

Causes

Life-threatening causes

  • Life-threatening causes of PR include chest trauma.

Common causes

Less common causes

Causes by etiology

  • PR may be physiologic or pathologic. Pathologic causes may be divided among primary and secondary. Isolated PR is very rare and is most commonly associated with other congenital heart diseases.[10] The following flow chart demonstrates the causes of PR based upon the etiology.


 
 
 
 
 
 
 
 
 
 
 
 
Causes of Pulmonic regurgitation (PR)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physiologic[11][12][13]
Mostly found among healthy young people on doppler echo
 
 
 
 
Primary[14]
 
 
 
Secondary[15][14][4][16][7][8][17]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Pulmonary artery dilation/
right ventricular outlet aneurysm
(congenital, tertiary syphilis,
Behçet disease, or Marfan syndrome}
 
 
 
•Pulmonary hypertension
(SLE can be a cause)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acquired
 
 
 
Congenital[15]
•Quadricuspid or Bicuspid valves
•Valvular hypoplasia
•pulmonary valve prolapse
•Absent pulmonary valve
•Isolated congenital PR
•Ebstein’s anomaly (acute PR)
•Peripheral pulmonary artery stenosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trauma (usually life-threatening)[14]
•Blunt or penetrating chest trauma
•Myocardial rupture
 
Infectious/Immune-related[15]
•Infective endocarditis (can be life-threatening)
•Rheumatic heart disease
 
 
 
 
Tumor/Genetic causes[15][18]
•Carconoid heart disease
•Myxomatous degeneration of the pulmonary valve
 
Iatrogenic[15][19][20][21]
•Post pulmonary valve stenosis repair
• Post TOF transannular patch repair
•Post Blalock-Taussig shunt TOF repair
•Post balloon or surgical valvulotomy or valvuloplasty for pulmonary stenosis (acute PR)
•Perforation of valvular pulmonary atresia (acute PR)
•Medications acting via serotonergic pathways such as ergot derivatives (Pergolide)[22][23]
 


Causes by Organ System[14][18][19][20][21][24][4][17][9]


Cardiovascular Congenital heart disease, dilated cardiomyopathy, Eisenmenger syndrome, endocarditis, infective endocarditis, myocardial rupture, patent ductus arteriosus, rheumatic heart disease, right ventricular tumors, myxomatous degeneration of the pulmonary valve, and Takayasu arteritis
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cabergoline, ergotamine, fenfluramine, fluoxetine, methysergide, paroxetine, pergolide, phentermine, sertraline
Ear Nose Throat No underlying causes
Endocrine Carcinoid syndrome
Environmental Pneumoconiosis
Gastroenterologic No underlying causes
Genetic Mucopolysaccharidoses, patent ductus arteriosus, polycystic kidney disease, X-linked dilated cardiomyopathy, Marfan syndrome
Hematologic No underlying causes
Iatrogenic Balloon valvuloplasty of the pulmonary valve, cardiac catheterization, cardiopulmonary resuscitation, heart surgery, pacemaker syndrome, percutaneous coronary intervention, prosthetic valve dysfunction, Tetralogy of Fallot repair
Infectious Disease Infective endocarditis, myocarditis, rheumatic fever, tertiary syphilis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Gouty valvular tophi
Obstetric/Gynecologic No underlying causes
Oncologic Carcinoid syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Cor pulmonale, idiopathic pulmonary fibrosis, Langerhans cell histiocytosis, pneumoconiosis, pulmonary hypertension, sarcoidosis
Renal/Electrolyte End stage renal disease, polycystic kidney disease
Rheumatology/Immunology/Allergy Rheumatic fever, sarcoidosis, Behçet disease
Sexual No underlying causes
Trauma Blunt or penetrating chest trauma
Urologic No underlying causes
Miscellaneous SLE


Causes in alphabetical order

References

  1. ↑ Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
  2. ↑ Warnes, Carole A.; Williams, Roberta G.; Bashore, Thomas M.; Child, John S.; Connolly, Heidi M.; Dearani, Joseph A.; del Nido, Pedro; Fasules, James W.; Graham, Thomas P.; Hijazi, Ziyad M.; Hunt, Sharon A.; King, Mary Etta; Landzberg, Michael J.; Miner, Pamela D.; Radford, Martha J.; Walsh, Edward P.; Webb, Gary D. (2008). "ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary". Circulation. 118 (23): 2395–2451. doi:10.1161/CIRCULATIONAHA.108.190811. ISSN 0009-7322.
  3. ↑ Weinberg, Catherine R.; McElhinney, Doff B. (2014). "Pulmonary Valve Replacement in Tetralogy of Fallot". Circulation. 130 (9): 795–798. doi:10.1161/CIRCULATIONAHA.114.005551. ISSN 0009-7322.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Saremi, Farhood; Gera, Atul; Yen Ho, S.; Hijazi, Ziyad M.; Sánchez-Quintana, Damián (2014). "CT and MR Imaging of the Pulmonary Valve". RadioGraphics. 34 (1): 51–71. doi:10.1148/rg.341135026. ISSN 0271-5333.
  5. ↑ Sharma RK, Talwar D, Gupta SK, Bansal S (2016). "Idiopathic dilatation of pulmonary artery". Lung India. 33 (6): 675–677. doi:10.4103/0970-2113.192869. PMC 5112830. PMID 27891002.
  6. ↑ Malviya A, Jha PK, Kalita JP, Saikia MK, Mishra A (2017). "Idiopathic dilatation of pulmonary artery: A review". Indian Heart J. 69 (1): 119–124. doi:10.1016/j.ihj.2016.07.009. PMC 5319124. PMID 28228295.
  7. ↑ 7.0 7.1 Deb SJ, Zehr KJ, Shields RC (October 2005). "Idiopathic pulmonary artery aneurysm". Ann. Thorac. Surg. 80 (4): 1500–2. doi:10.1016/j.athoracsur.2004.04.011. PMID 16181901.
  8. ↑ 8.0 8.1 Xie D, Chen C, Wang H, Xu Z, Jiang G (September 2015). "Refractory pulmonary artery aneurysm in Behçet's disease". Ann Transl Med. 3 (16): 239. doi:10.3978/j.issn.2305-5839.2015.09.27. PMC 4598455. PMID 26539456.
  9. ↑ 9.0 9.1 Yang, Jing; Peng, Min; Shi, Juhong; Zheng, Wenjie; Yu, Xuezhong (2019). "Pulmonary artery involvement in Takayasu's arteritis: diagnosis before pulmonary hypertension". BMC Pulmonary Medicine. 19 (1). doi:10.1186/s12890-019-0983-7. ISSN 1471-2466.
  10. ↑ Chaturvedi RR, Redington AN (2007). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–9. doi:10.1136/hrt.2005.075234. PMC 1994453. PMID 17569817.
  11. ↑ Macchi C, Orlandini SZ, Orlandini GE (January 1994). "An anatomical study of the healthy human heart by echocardiography with special reference to physiological valvular regurgitation". Ann. Anat. 176 (1): 81–6. doi:10.1016/s0940-9602(11)80421-8. PMID 8304596.
  12. ↑ Král J, Hradec J, Petrásek J (1989). "Valvular regurgitations in healthy young people". Cor Vasa. 31 (6): 485–94. PMID 2637102.
  13. ↑ Maciel BC, Simpson IA, Valdes-Cruz LM, Recusani F, Hoit B, Dalton N, Weintraub R, Sahn DJ (1991). "Color flow Doppler mapping studies of "physiologic" pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume". J Am Soc Echocardiogr. 4 (6): 589–97. doi:10.1016/s0894-7317(14)80218-6. PMID 1760180.
  14. ↑ 14.0 14.1 14.2 14.3 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease)". Circulation. 118 (23): 2395–451. doi:10.1161/CIRCULATIONAHA.108.190811. PMID 18997168.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 Lancellotti, P.; Tribouilloy, C.; Hagendorff, A.; Moura, L.; Popescu, B. A.; Agricola, E.; Monin, J. L.; Pierard, L. A.; Badano, L.; Zamorano, J. L.; Sicari, R.; Vahanian, A.; Roelandt, J. R. T. C. (2010). "European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)". European Journal of Echocardiography. 11 (3): 223–244. doi:10.1093/ejechocard/jeq030. ISSN 1525-2167.
  16. ↑ Tselios K, Gladman DD, Urowitz MB (2017). "Systemic lupus erythematosus and pulmonary arterial hypertension: links, risks, and management strategies". Open Access Rheumatol. 9: 1–9. doi:10.2147/OARRR.S123549. PMC 5191623. PMID 28053559.
  17. ↑ 17.0 17.1 Nollen GJ, van Schijndel KE, Timmermans J, Groenink M, Barentsz JO, van der Wall EE, Stoker J, Mulder BJ (May 2002). "Pulmonary artery root dilatation in Marfan syndrome: quantitative assessment of an unknown criterion". Heart. 87 (5): 470–1. doi:10.1136/heart.87.5.470. PMC 1767105. PMID 11997425.
  18. ↑ 18.0 18.1 Fox DJ, Khattar RS (October 2004). "Carcinoid heart disease: presentation, diagnosis, and management". Heart. 90 (10): 1224–8. doi:10.1136/hrt.2004.040329. PMC 1768473. PMID 15367531.
  19. ↑ 19.0 19.1 Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P; et al. (2001). "Long-term results after early primary repair of tetralogy of Fallot". J Thorac Cardiovasc Surg. 122 (1): 154–61. doi:10.1067/mtc.2001.115156. PMID 11436049.
  20. ↑ 20.0 20.1 Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS (2016). "Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI)". J Thorac Imaging. 31 (1): W4–12. doi:10.1097/RTI.0000000000000182. PMID 26656195.
  21. ↑ 21.0 21.1 Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D; et al. (2015). "Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future". J Am Coll Cardiol. 66 (20): 2246–55. doi:10.1016/j.jacc.2015.09.055. PMID 26564602.
  22. ↑ Corvol, Jean-Christophe; Anzouan-Kacou, Jean-Baptiste; Fauveau, Elodie; Bonnet, Anne-Marie; Lebrun-Vignes, Bénédicte; Girault, Camille; Agid, Yves; Lechat, Philippe; Isnard, Richard; Lacomblez, Lucette (2007). "Heart Valve Regurgitation, Pergolide Use, and Parkinson Disease". Archives of Neurology. 64 (12): 1721. doi:10.1001/archneur.64.12.1721. ISSN 0003-9942.
  23. ↑ Smith SA, Waggoner AD, de las Fuentes L, Davila-Roman VG (August 2009). "Role of serotoninergic pathways in drug-induced valvular heart disease and diagnostic features by echocardiography". J Am Soc Echocardiogr. 22 (8): 883–9. doi:10.1016/j.echo.2009.05.002. PMC 3808845. PMID 19553085.
  24. ↑ Curtiss, E I; Miller, T R; Shapiro, L S (1983). "Pulmonic regurgitation due to valvular tophi". Circulation. 67 (3): 699–701. doi:10.1161/01.CIR.67.3.699. ISSN 0009-7322.
  25. ↑ Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J (2009). "Drug-induced fibrotic valvular heart disease". Lancet. 374 (9689): 577–85. doi:10.1016/S0140-6736(09)60252-X. PMID 19683643.
  26. ↑ Sharma S, Kirpalani AL, Kulkarni A (2010). "Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis". Ann Pediatr Cardiol. 3 (2): 184–6. doi:10.4103/0974-2069.74055. PMC 3017928. PMID 21234203.
  27. ↑ Hendrikx M, Van Dorpe J, Flameng W, Daenen W (1996). "Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature". J Heart Valve Dis. 5 (2): 235–7. PMID 8665020.
  28. ↑ Wilke A, Hesse H, Hufnagel G, Maisch B (1997). "Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine". Eur Heart J. 18 (4): 701. PMID 9129909.
  29. ↑ Nadrous HF, Pellikka PA, Krowka MJ, Swanson KL, Chaowalit N, Decker PA; et al. (2005). "Pulmonary hypertension in patients with idiopathic pulmonary fibrosis". Chest. 128 (4): 2393–9. doi:10.1378/chest.128.4.2393. PMID 16236900.
  30. ↑ Chaowalit N, Pellikka PA, Decker PA, Aubry MC, Krowka MJ, Ryu JH; et al. (2004). "Echocardiographic and clinical characteristics of pulmonary hypertension complicating pulmonary Langerhans cell histiocytosis". Mayo Clin Proc. 79 (10): 1269–75. doi:10.4065/79.10.1269. PMID 15473409.
  31. ↑ Bana DS, MacNeal PS, LeCompte PM, Shah Y, Graham JR (1974). "Cardiac murmurs and endocardial fibrosis associated with methysergide therapy". Am Heart J. 88 (5): 640–55. PMID 4420941.
  32. ↑ Nelson J, Shields MD, Mulholland HC (1990). "Cardiovascular studies in the mucopolysaccharidoses". J Med Genet. 27 (2): 94–100. PMC 1016928. PMID 2108248.
  33. ↑ Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE (2002). "Valvular heart disease in patients taking pergolide". Mayo Clin Proc. 77 (12): 1280–6. doi:10.4065/77.12.1280. PMID 12479512.
  34. ↑ Adeva M, El-Youssef M, Rossetti S, Kamath PS, Kubly V, Consugar MB; et al. (2006). "Clinical and molecular characterization defines a broadened spectrum of autosomal recessive polycystic kidney disease (ARPKD)". Medicine (Baltimore). 85 (1): 1–21. doi:10.1097/01.md.0000200165.90373.9a. PMID 16523049.
  35. ↑ Arkles JS, Opotowsky AR, Ojeda J, Rogers F, Liu T, Prassana V; et al. (2011). "Shape of the right ventricular Doppler envelope predicts hemodynamics and right heart function in pulmonary hypertension". Am J Respir Crit Care Med. 183 (2): 268–76. doi:10.1164/rccm.201004-0601OC. PMID 20709819.
  36. ↑ Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004). "Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging". J Am Coll Cardiol. 43 (6): 1068–74. doi:10.1016/j.jacc.2003.10.045. PMID 15028368.
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