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| ** It is accentuated by inspiration. | | ** It is accentuated by inspiration. |
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| ==Sources==
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| * Bouzbas, B., Kilner, P. J., & Gatzoulis, M. A. (2005). Pulmonary regurgitation: not a benign lesion. ''European Heart Journal'', 433-9. <ref name="pmid15640261">{{cite journal| author=Bouzas B, Kilner PJ, Gatzoulis MA| title=Pulmonary regurgitation: not a benign lesion. | journal=Eur Heart J | year= 2005 | volume= 26 | issue= 5 | pages= 433-9 | pmid=15640261 | doi=10.1093/eurheartj/ehi091 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640261 }} </ref>
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| * Wessel, H. U., Cunningham, W. J., Paul, M. H., Bastanier, C. K., Muster, A. J., & Idriss, F. S. (1980). Exercise performance in tetralogy of Fallot after intracardiac repair. ''Journal of Thoracic and Cardiovascular Surgery'', 582-93. <ref name="pmid7421291">{{cite journal| author=Wessel HU, Cunningham WJ, Paul MH, Bastanier CK, Muster AJ, Idriss FS| title=Exercise performance in tetralogy of Fallot after intracardiac repair. | journal=J Thorac Cardiovasc Surg | year= 1980 | volume= 80 | issue= 4 | pages= 582-93 | pmid=7421291 | doi= | pmc= | url= }} </ref>
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| * Shimazaki, Y., Blackstone, E. H., & Kirklin, J. W. (1984). The natural history of isolated congenital pulmonary valve incompetence: surgical implications. ''Journal of Thoracic and Cardiovascular Surgery'', 257-9. <ref name="pmid6207619">{{cite journal| author=Shimazaki Y, Blackstone EH, Kirklin JW| title=The natural history of isolated congenital pulmonary valve incompetence: surgical implications. | journal=Thorac Cardiovasc Surg | year= 1984 | volume= 32 | issue= 4 | pages= 257-9 | pmid=6207619 | doi=10.1055/s-2007-1023399 | pmc= | url= }} </ref>
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| * Geva, T., Sandweiss, B. M., Gauvreau, K., Lock, J. E., & Powell, A. (2004). Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. ''Journal of the American College of Cardiology'', 1068-74. <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>
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| ==References== | | ==References== |
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
Physical Examination
Neck
Palpation
- A palpable impulse (lift or heave) is usually present at the left lower sternal border because of right ventricular dilation.
Auscultation
Heart Sounds
- Pulmonic regurgitation is associated with wide splitting of S2.
- P2 is accentuated because of presence of pulmonary regurgitation. In case of, absence of pulmonic valves (congenital or secondary to surgical resection), P2 is inaudible.
- A right-sided S3 may be audible and may also be accentuated with inspiration.
- Likewise, a right-sided S4 may also be audible and accentuated with inspiration.
Murmur
- Murmur of residual pulmonic regurgitation after Tetralogy of Fallot repair:
- It is a low-pitched and soft murmur.
- Best heard along the second or third intercostal spaces adjacent to the left sternal border.
- It is accentuated by squatting and inspiration.
- It is made softer by Valsalva maneuvers or expiration.
- Murmur of pulmonic regurgitation associated with Pulmonic hypertension:
- When the pulmonary artery systolic pressure exceeds 60 mm Hg, dilatation of the pulmonary artery ring may then result in Graham-Steell's murmur.
- It is a high-pitched, "blowing", early diastolic decrescendo murmur like that of aortic regurgitation.
- Best heard along the left parasternal region.
- It is accentuated by inspiration.
References
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