Pulmonic regurgitation causes: Difference between revisions
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{{CMG}}; {{AE}} {{M.P}} | {{CMG}}; {{AE}} {{M.P}} {{AKI}}, {{AA}}, {{JA}} | ||
==Overview== | ==Overview== | ||
Pulmonic regurgitation | [[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}} | ||
{{familytree | | | | | | | | | | | | | A01 | | | | | |A01='''Causes of [[Pulmonic regurgitation]]''' (PR)}} | |||
{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| }} | |||
{{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> }} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | |!| }} | |||
{{familytree | | | | | | | | | | | | | |!| | |,|-|-|^|-|-|.|}} | |||
{{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)}} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | |,|-|-|^|-|-|.| | | | | }} | |||
{{familytree | | | | | | | | | | |!| | | | | |!| | | | | }} | |||
{{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]]}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | | | }} | |||
{{familytree | | |,|-|-|-|v|-|-|-|^|-|-|v|-|-|-|.| | | | }} | |||
{{familytree | | |!| | | |!| | | | | | |!| | | |!| }} | |||
{{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}}<br> | |||
===Causes by Organ System=== | ===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 60: | 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 72: | 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 84: | Line 109: | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Nutritional/Metabolic''' | | '''Nutritional/Metabolic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"|[[Gout|Gouty]] valvular [[tophus|tophi]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
Line 112: | Line 137: | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Renal/Electrolyte''' | | '''Renal/Electrolyte''' | ||
|bgcolor="Beige"| [[ | |bgcolor="Beige"| [[End stage renal disease]], [[polycystic kidney disease]] | ||
|- | |- | ||
|-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 132: | Line 157: | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Miscellaneous''' | | '''Miscellaneous''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[SLE]] | ||
|- | |- | ||
|} | |} | ||
<br> | |||
===Causes in | ===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 151: | Line 177: | ||
*[[Eisenmenger syndrome]] | *[[Eisenmenger syndrome]] | ||
*[[Endocarditis]] | *[[Endocarditis]] | ||
*[[End stage renal disease]]<ref name="pmid21234203">{{cite journal| author=Sharma S, Kirpalani AL, Kulkarni A| title=Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis. | journal=Ann Pediatr Cardiol | year= 2010 | volume= 3 | issue= 2 | pages= 184-6 | pmid=21234203 | doi=10.4103/0974-2069.74055 | pmc=PMC3017928 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21234203 }} </ref> | |||
*[[Ergotamine]]<ref name="pmid8665020">{{cite journal| author=Hendrikx M, Van Dorpe J, Flameng W, Daenen W| title=Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature. | journal=J Heart Valve Dis | year= 1996 | volume= 5 | issue= 2 | pages= 235-7 | pmid=8665020 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665020 }} </ref><ref name="pmid9129909">{{cite journal| author=Wilke A, Hesse H, Hufnagel G, Maisch B| title=Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 4 | pages= 701 | pmid=9129909 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9129909 }} </ref> | *[[Ergotamine]]<ref name="pmid8665020">{{cite journal| author=Hendrikx M, Van Dorpe J, Flameng W, Daenen W| title=Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature. | journal=J Heart Valve Dis | year= 1996 | volume= 5 | issue= 2 | pages= 235-7 | pmid=8665020 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665020 }} </ref><ref name="pmid9129909">{{cite journal| author=Wilke A, Hesse H, Hufnagel G, Maisch B| title=Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 4 | pages= 701 | pmid=9129909 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9129909 }} </ref> | ||
{{col-break|width=33%}} | |||
*[[Fenfluramine]] | *[[Fenfluramine]] | ||
*[[Fluoxetine]] | *[[Fluoxetine]] | ||
*[[Heart surgery]] | *[[Heart surgery]] | ||
Line 164: | Line 191: | ||
*[[Myocardial rupture]] | *[[Myocardial rupture]] | ||
*[[Myocarditis]] | *[[Myocarditis]] | ||
*[[Myxomatous degeneration]] of the [[pulmonary valve]] | |||
*[[Pacemaker syndrome]] | *[[Pacemaker syndrome]] | ||
*[[Paroxetine]] | *[[Paroxetine]] | ||
Line 180: | 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}} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
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
Common causes
- Secondary PR is more common than primary PR.[1]
- Pulmonic regurgitation (PR) is most common after TOF or pulmonary stenosis repair .[2][3]
- PR is also common among patients with pulmonary hypertension (PAH).[4]
Less common causes
- Carcinoid heart disease, infective endocarditis, tertiary syphilis, and connective tissue disorders are uncommon causes of PR.[4]
- 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.[5][6]
- 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. Atherosclerotic, degenerative, and traumatic causes are also included.[7][8]
- Takayasu arteritis is a rare cause of PAH and may cause PR.[9]
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 by Organ System[14][18][19][20][21][24][4][17][9]
Causes in alphabetical order
References
- ↑ Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 7.0 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.
- ↑ 8.0 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.
- ↑ 9.0 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.
- ↑ 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.
- ↑ 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.
- ↑ Král J, Hradec J, Petrásek J (1989). "Valvular regurgitations in healthy young people". Cor Vasa. 31 (6): 485–94. PMID 2637102.
- ↑ 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.
- ↑ 14.0 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.
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