Pulmonic regurgitation natural history, complications and prognosis: Difference between revisions
Jump to navigation
Jump to search
| Line 15: | Line 15: | ||
===Complications=== | ===Complications=== | ||
*Common complications of [[pulmonary regurgitation]] (PR) include:<ref name="pmid17601398">{{cite journal| author=Gregg D, Foster E| title=Pulmonary insufficiency is the nexus of late complications in tetralogy of Fallot. | journal=Curr Cardiol Rep | year= 2007 | volume= 9 | issue= 4 | pages= 315-22 | pmid=17601398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17601398 }} </ref><ref name="pmid12381647">{{cite journal| author=Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J et al.| title=ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation. | journal=Heart | year= 2002 | volume= 88 | issue= 5 | pages= 515-9 | pmid=12381647 | doi= | pmc=1767425 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12381647 }} </ref><ref name="pmid15364855">{{cite journal| author=Frigiola A, Redington AN, Cullen S, Vogel M| title=Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. | journal=Circulation | year= 2004 | volume= 110 | issue= 11 Suppl 1 | pages= II153-7 | pmid=15364855 | doi=10.1161/01.CIR.0000138397.60956.c2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15364855 }} </ref><ref name="pmid20713900">{{cite journal| author=Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J et al.| title=Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. | journal=Circulation | year= 2010 | volume= 122 | issue= 9 | pages= 868-75 | pmid=20713900 | doi=10.1161/CIRCULATIONAHA.109.928481 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20713900 }} </ref><ref name="pmid11041398">{{cite journal |vauthors=Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakazawa M, Moller JH, Gillette PC, Webb GD, Redington AN |title=Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study |journal=Lancet |volume=356 |issue=9234 |pages=975–81 |date=September 2000 |pmid=11041398 |doi=10.1016/S0140-6736(00)02714-8 |url=}}</ref><ref name="BouzasKilner2005">{{cite journal|last1=Bouzas|first1=Beatriz|last2=Kilner|first2=Philip J.|last3=Gatzoulis|first3=Michael A.|title=Pulmonary regurgitation: not a benign lesion|journal=European Heart Journal|volume=26|issue=5|year=2005|pages=433–439|issn=0195-668X|doi=10.1093/eurheartj/ehi091}}</ref> | |||
*Progressive [[right ventricular]] dilatation | *#Progressive [[right ventricular]](RV) dilatation | ||
*[[Heart failure]] | *#[[RV]] dysfunction | ||
*[[Tricuspid regurgitation]] | *#[[Heart failure]] (HF): Exercise intolerance is one of the features of [[Heart failure|HF]]. To read about the degree of [[Heart failure|HF]] and its manifestations according to NYHA classification [[New york heart association functional classification|click here]]. | ||
*Ventricular [[ | *#[[Tricuspid regurgitation]] | ||
*[[Sudden cardiac death]]: In [[patients]] with repaired [[TOF]], [[pulmonic regurgitation]] is a major hemodynamic lesion associated with [[ventricular tachycardia]] and [[sudden cardiac death]]. | *#Ventricular [[arrhythmias]] (such as [[ventricular tachycardia]]) | ||
*#[[Sudden cardiac death]]: In [[patients]] with repaired [[TOF]], [[pulmonic regurgitation]] is a major hemodynamic lesion associated with [[ventricular tachycardia]] and [[sudden cardiac death]]. | |||
*#[[Nutmeg liver|Hepatic congestion]] may develop secondary to [[right heart failure]]. [[Hepatic dysfunction]] may ensue [[thromboembolic]] events. | |||
*Common complications of [[pulmonary regurgitation]] (PR) [[treatment]] include: | |||
**Complications post [[pulmonic valve]] replacement (PVR) are<ref name="pmid22921969">{{cite journal |vauthors=Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY, Shim WS, Choi EY, Lee SY, Baek JS |title=Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement |journal=J. Am. Coll. Cardiol. |volume=60 |issue=11 |pages=1005–14 |date=September 2012 |pmid=22921969 |doi=10.1016/j.jacc.2012.03.077 |url=}}</ref>: | |||
**#[[Prosthetic valve]] failure (PVR or interventional catheter procedure is required to be redone). | |||
**#[[Prosthetic valve]] dysfunction (death due to [[prosthetic valve]] dysfunction is very rare). | |||
**#[[Atrial fibrillation]] and [[atrial flutter]] are rare complications. | |||
**After transcatheter [[pulmonic valve]] implantation (TPVI), [[infective endocarditis]] is not an uncommon complication. A few [[patients]] (such as of [[streptococcus|streptococcal infection]]) may be managed medically and surgical or [[percutaneous]] reintervention may be required for others.<ref name="AbdelghaniNassif2018">{{cite journal|last1=Abdelghani|first1=Mohammad|last2=Nassif|first2=Martina|last3=Blom|first3=Nico A.|last4=Van Mourik|first4=Martijn S.|last5=Straver|first5=Bart|last6=Koolbergen|first6=David R.|last7=Kluin|first7=Jolanda|last8=Tijssen|first8=Jan G.|last9=Mulder|first9=Barbara J. M.|last10=Bouma|first10=Berto J.|last11=de Winter|first11=Robbert J.|title=Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review|journal=Journal of the American Heart Association|volume=7|issue=13|year=2018|issn=2047-9980|doi=10.1161/JAHA.117.008163}}</ref> | |||
===Prognosis=== | ===Prognosis=== | ||
Revision as of 13:34, 3 August 2020
|
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
Majority of patients with mild pulmonary regurgitation (PR) are asymptomatic and have a benign course, not progressing to chronic PR. Patients tolerate severe chronic PR for a long period of time and begin to develop symptoms when the right ventricle function begins to decline. Chronic severe PR leads to progressive dilation and systolic dysfunction of the right ventricle resulting in symptoms.[1] Complications which may result from pulmonary regurgitation include progressive right ventricular dilatation, heart failure, tricuspid regurgitation, ventricular arrythmias, and sudden cardiac death. Symptomatic patients are treated with pulmonary valve replacement and have a good prognosis.[2]
Natural History, Complications, and Prognosis
Natural history
- Mild PR is a very common finding on 2D echo.[1]
- Majority of patients with mild PR are asymptomatic and have a beningn course, not progressing to chronic PR.
- Patients tolerate severe chronic PR for a long period of time and begin to develop symptoms when the right ventricle function begins to decline.
- Chronic severe PR leads to progressive dilation and systolic dysfunction of the right ventricle resulting in symptoms.
- Patients with acute worsening of PR should be evaluated for associated conditions such as pulmonary hypertension which increase the pressure gradient.
Complications
- Common complications of pulmonary regurgitation (PR) include:[3][4][5][6][7][8]
- Progressive right ventricular(RV) dilatation
- RV dysfunction
- Heart failure (HF): Exercise intolerance is one of the features of HF. To read about the degree of HF and its manifestations according to NYHA classification click here.
- Tricuspid regurgitation
- Ventricular arrhythmias (such as ventricular tachycardia)
- Sudden cardiac death: In patients with repaired TOF, pulmonic regurgitation is a major hemodynamic lesion associated with ventricular tachycardia and sudden cardiac death.
- Hepatic congestion may develop secondary to right heart failure. Hepatic dysfunction may ensue thromboembolic events.
- Common complications of pulmonary regurgitation (PR) treatment include:
- Complications post pulmonic valve replacement (PVR) are[2]:
- Prosthetic valve failure (PVR or interventional catheter procedure is required to be redone).
- Prosthetic valve dysfunction (death due to prosthetic valve dysfunction is very rare).
- Atrial fibrillation and atrial flutter are rare complications.
- After transcatheter pulmonic valve implantation (TPVI), infective endocarditis is not an uncommon complication. A few patients (such as of streptococcal infection) may be managed medically and surgical or percutaneous reintervention may be required for others.[9]
- Complications post pulmonic valve replacement (PVR) are[2]:
Prognosis
- The prognosis of pulmonic regurgitation depends on the severity of the condition, etiology and associated complications.[10]
- Mild to moderate PR is not associated with shortened survival.[10]
- The prognosis of symptomatic patients of PR is good after pulmonary valve replacement.[2] Surgical Pulmonic Valve Repair (PVR) improves right ventricular filling and increases left ventricular stroke volume.[11] Ten year overall and event-free survival after PVR is 98% and 70%, respectively.[12]
- Among patients with pulmonary hypertension (PAH), the severity and duration of PAH determines the ultimate prognosis.
- The prognosis of PR due to congenital absence of pulmonic valve is poor and may limit patient's life expectancy in the absence of valve replacement. Absent pulmonary valve (APVS) is associated with severe regurgitation and complications secondary to respiratory distress.[13]
- Higher pre-operative RV end-systolic volume index (ESVI) is the only independent risk factor for suboptimal outcomes post pulmonary valve replacement.[12]
References
- ↑ 1.0 1.1 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: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
- ↑ 2.0 2.1 2.2 Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY; et al. (2012). "Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement". J Am Coll Cardiol. 60 (11): 1005–14. doi:10.1016/j.jacc.2012.03.077. PMID 22921969.
- ↑ Gregg D, Foster E (2007). "Pulmonary insufficiency is the nexus of late complications in tetralogy of Fallot". Curr Cardiol Rep. 9 (4): 315–22. PMID 17601398.
- ↑ Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J; et al. (2002). "ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation". Heart. 88 (5): 515–9. PMC 1767425. PMID 12381647.
- ↑ Frigiola A, Redington AN, Cullen S, Vogel M (2004). "Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot". Circulation. 110 (11 Suppl 1): II153–7. doi:10.1161/01.CIR.0000138397.60956.c2. PMID 15364855.
- ↑ Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J; et al. (2010). "Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study". Circulation. 122 (9): 868–75. doi:10.1161/CIRCULATIONAHA.109.928481. PMID 20713900.
- ↑ Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C, Rosenthal M, Nakazawa M, Moller JH, Gillette PC, Webb GD, Redington AN (September 2000). "Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study". Lancet. 356 (9234): 975–81. doi:10.1016/S0140-6736(00)02714-8. PMID 11041398.
- ↑ Bouzas, Beatriz; Kilner, Philip J.; Gatzoulis, Michael A. (2005). "Pulmonary regurgitation: not a benign lesion". European Heart Journal. 26 (5): 433–439. doi:10.1093/eurheartj/ehi091. ISSN 0195-668X.
- ↑ Abdelghani, Mohammad; Nassif, Martina; Blom, Nico A.; Van Mourik, Martijn S.; Straver, Bart; Koolbergen, David R.; Kluin, Jolanda; Tijssen, Jan G.; Mulder, Barbara J. M.; Bouma, Berto J.; de Winter, Robbert J. (2018). "Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review". Journal of the American Heart Association. 7 (13). doi:10.1161/JAHA.117.008163. ISSN 2047-9980.
- ↑ 10.0 10.1 Pendela VS, Ayyad R. PMID 31985929. Missing or empty
|title=(help) - ↑ Frigiola, A.; Giardini, A.; Taylor, A.; Tsang, V.; Derrick, G.; Khambadkone, S.; Walker, F.; Cullen, S.; Bonhoeffer, P.; Marek, J. (2012). "Echocardiographic assessment of diastolic biventricular properties in patients operated for severe pulmonary regurgitation and association with exercise capacity". European Heart Journal - Cardiovascular Imaging. 13 (8): 697–702. doi:10.1093/ehjci/jes002. ISSN 2047-2404.
- ↑ 12.0 12.1 Lee, Cheul; Kim, Yang Min; Lee, Chang-Ha; Kwak, Jae Gun; Park, Chun Soo; Song, Jin Young; Shim, Woo-Sup; Choi, Eun Young; Lee, Sang Yun; Baek, Jae Suk (2012). "Outcomes of Pulmonary Valve Replacement in 170 Patients With Chronic Pulmonary Regurgitation After Relief of Right Ventricular Outflow Tract Obstruction". Journal of the American College of Cardiology. 60 (11): 1005–1014. doi:10.1016/j.jacc.2012.03.077. ISSN 0735-1097.
- ↑ Grewal DS, Chamoli SC, Saxena S (April 2014). "Absent pulmonary valve syndrome - Antenatal diagnosis". Med J Armed Forces India. 70 (2): 198–200. doi:10.1016/j.mjafi.2013.07.002. PMC 4017172. PMID 24843213.