Pulmonic regurgitation pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Pathophysiologic mechanism of pulmonic regurgitation | Pathophysiologic mechanism of pulmonic regurgitation: | ||
*Patients with | *Patients with [[pulmonic regurgitation]] develop chronic [[right ventricular overload]] resulting in right [[ventricular remodelling]] and progressive decline in function.<ref name="pmid26430501">{{cite journal| author=Bigdelian H, Mardani D, Sedighi M| title=The Effect of Pulmonary Valve Replacement (PVR) Surgery on Hemodynamics of Patients Who Underwent Repair of Tetralogy of Fallot (TOF). | journal=J Cardiovasc Thorac Res | year= 2015 | volume= 7 | issue= 3 | pages= 122-5 | pmid=26430501 | doi=10.15171/jcvtr.2015.26 | pmc=4586599 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26430501 }} </ref> | ||
*Progressive dilation of the right ventricle results in functional tricuspid regurgitation and increases the risk of developing arrhythmias. | *Progressive dilation of the [[right ventricle]] results in functional [[tricuspid regurgitation]] and increases the risk of developing [[arrhythmias]]. | ||
*The rate of decline in right ventricular systolic function is affected by associated conditions such as peripheral pulmonary artery stenosis and pulmonary hypertension which further increase the severity of pulmonary regurgitation. | *The rate of decline in right ventricular [[systolic function]] is affected by associated conditions such as peripheral [[pulmonary artery stenosis]] and [[pulmonary hypertension]] which further increase the severity of pulmonary regurgitation. | ||
*In patients with increased pulmonary artery pressure from dysfunction of | *In patients with increased [[pulmonary artery pressure]] from dysfunction of [[left ventricle]] or residual [[pulmonary artery stenosis]] increases the severity of [[pulmonary regurgitation]]. | ||
*The severity of regurgitant jet is dependent on:<ref name="pmid26430501">{{cite journal| author=Bigdelian H, Mardani D, Sedighi M| title=The Effect of Pulmonary Valve Replacement (PVR) Surgery on Hemodynamics of Patients Who Underwent Repair of Tetralogy of Fallot (TOF). | journal=J Cardiovasc Thorac Res | year= 2015 | volume= 7 | issue= 3 | pages= 122-5 | pmid=26430501 | doi=10.15171/jcvtr.2015.26 | pmc=4586599 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26430501 }} </ref> | *The severity of [[regurgitant jet]] is dependent on:<ref name="pmid26430501">{{cite journal| author=Bigdelian H, Mardani D, Sedighi M| title=The Effect of Pulmonary Valve Replacement (PVR) Surgery on Hemodynamics of Patients Who Underwent Repair of Tetralogy of Fallot (TOF). | journal=J Cardiovasc Thorac Res | year= 2015 | volume= 7 | issue= 3 | pages= 122-5 | pmid=26430501 | doi=10.15171/jcvtr.2015.26 | pmc=4586599 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26430501 }} </ref> | ||
**Size of the regurgitant orifice | **Size of the [[regurgitant orifice]] | ||
**Afterload of the | **Afterload of the [[right ventricle]] | ||
** | **[[Right ventricle]] [[diastolic]] [[compliance]] | ||
**Duration of | **Duration of [[right ventricular]] [[diastole]] | ||
==== According to 2014, ACC/AHA valvular heart disease guidelines the stages of severe pulmonary regurgitation are described as follows:<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191 }} </ref> ==== | ==== According to 2014, ACC/AHA valvular heart disease guidelines the stages of severe pulmonary regurgitation are described as follows:<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191 }} </ref> ==== | ||
{| class="wikitable" | {| class="wikitable" | ||
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|- | |- | ||
|C,D | |C,D | ||
|Severe | |Severe Pulmonary valve regurgitation | ||
| | | | ||
*Distorted or absent leaflets | *Distorted or absent leaflets | ||
*Annular dilation | *Annular dilation | ||
| | | | ||
*Color jet fills | *Color jet fills [[right ventricular outlet tract]] | ||
*CW jet density and contour: dense laminar flow with steep deceleration slope; may terminate abruptly | *CW jet density and contour: dense laminar flow with steep deceleration slope; may terminate abruptly | ||
| | | | ||
*Paradoxical septal motion (volume overload pattern) | *Paradoxical septal motion (volume overload pattern) | ||
* | *Right ventricular enlargement | ||
|None or variable and dependent on cause of | |None or variable and dependent on cause of pulmonary reguritation and right ventricular function | ||
|} | |} | ||
Revision as of 15:44, 31 March 2017
|
Pulmonic regurgitation Microchapters |
|
Diagnosis |
|---|
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3]
Overview
Pathophysiologic mechanism of pulmonic regurgitation include right ventricular overload resulting in right ventricular remodelling and progressive decline in function. The rate of decline in right ventricular systolic function is affected by associated conditions such as peripheral pulmonary artery stenosis and pulmonary hypertension which further increase the severity of pulmonary regurgitation.[1]
Pathophysiology
Pathophysiologic mechanism of pulmonic regurgitation:
- Patients with pulmonic regurgitation develop chronic right ventricular overload resulting in right ventricular remodelling and progressive decline in function.[1]
- Progressive dilation of the right ventricle results in functional tricuspid regurgitation and increases the risk of developing arrhythmias.
- The rate of decline in right ventricular systolic function is affected by associated conditions such as peripheral pulmonary artery stenosis and pulmonary hypertension which further increase the severity of pulmonary regurgitation.
- In patients with increased pulmonary artery pressure from dysfunction of left ventricle or residual pulmonary artery stenosis increases the severity of pulmonary regurgitation.
- The severity of regurgitant jet is dependent on:[1]
- Size of the regurgitant orifice
- Afterload of the right ventricle
- Right ventricle diastolic compliance
- Duration of right ventricular diastole
According to 2014, ACC/AHA valvular heart disease guidelines the stages of severe pulmonary regurgitation are described as follows:[2]
| Stage | Definition | Pulmonary Valve
Anatomy |
Valve Hemodynamics | Hemodynamic Consequences | Symptoms |
|---|---|---|---|---|---|
| C,D | Severe Pulmonary valve regurgitation |
|
|
|
None or variable and dependent on cause of pulmonary reguritation and right ventricular function |
References
- ↑ 1.0 1.1 1.2 Bigdelian H, Mardani D, Sedighi M (2015). "The Effect of Pulmonary Valve Replacement (PVR) Surgery on Hemodynamics of Patients Who Underwent Repair of Tetralogy of Fallot (TOF)". J Cardiovasc Thorac Res. 7 (3): 122–5. doi:10.15171/jcvtr.2015.26. PMC 4586599. PMID 26430501.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.