Pulmonic regurgitation classification: Difference between revisions
Jump to navigation
Jump to search
Farima Kahe (talk | contribs) No edit summary |
|||
| Line 7: | Line 7: | ||
==Classification== | ==Classification== | ||
[[Pulmonary valve]] [[regurgitation]] | [[Pulmonary valve]] [[regurgitation]] may be classified into the following types based on the [[etiology]] of the [[regurgitation|regurgitant flow]] and severity of the disease:<ref name="ZoghbiAdams2017">{{cite journal|last1=Zoghbi|first1=William A.|last2=Adams|first2=David|last3=Bonow|first3=Robert O.|last4=Enriquez-Sarano|first4=Maurice|last5=Foster|first5=Elyse|last6=Grayburn|first6=Paul A.|last7=Hahn|first7=Rebecca T.|last8=Han|first8=Yuchi|last9=Hung|first9=Judy|last10=Lang|first10=Roberto M.|last11=Little|first11=Stephen H.|last12=Shah|first12=Dipan J.|last13=Shernan|first13=Stanton|last14=Thavendiranathan|first14=Paaladinesh|last15=Thomas|first15=James D.|last16=Weissman|first16=Neil J.|title=Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation|journal=Journal of the American Society of Echocardiography|volume=30|issue=4|year=2017|pages=303–371|issn=08947317|doi=10.1016/j.echo.2017.01.007}}</ref> | ||
===Based on the | ===Based on the Etiology=== | ||
[[Pulmonary valve]] regurgitation | [[Pulmonary valve]] regurgitation can be classified into primary and secondary types based on the intrinsic or extrinsic factors involved in the development of the disease: | ||
*'''Primary pulmonary regurgitation''': The [[pulmonary valve]] morphology is affected. 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> | *'''Primary pulmonary regurgitation''': The [[pulmonary valve]] morphology is affected. 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> | ||
*'''Secondary or functional pulmonary regurgitation''': The [[pulmonary valve]] function is normal. Conditions such as [[pulmonary hypertension]] and [[pulmonary artery]] [[aneursym]] cause dilation of the [[valve annulus]] resulting in [[regurgitation]].<ref name="pmid23922549">{{cite journal| author=Di Lullo L, Floccari F, Rivera R, Barbera V, Granata A, Otranto G et al.| title=Pulmonary Hypertension and Right Heart Failure in Chronic Kidney Disease: New Challenge for 21st-Century Cardionephrologists. | journal=Cardiorenal Med | year= 2013 | volume= 3 | issue= 2 | pages= 96-103 | pmid=23922549 | doi=10.1159/000350952 | pmc=3721135 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23922549 }} </ref> | *'''Secondary or functional pulmonary regurgitation''': The [[pulmonary valve]] function is normal. Conditions such as [[pulmonary hypertension]] and [[pulmonary artery]] [[aneursym]] cause dilation of the [[valve annulus]] resulting in [[regurgitation]].<ref name="pmid23922549">{{cite journal| author=Di Lullo L, Floccari F, Rivera R, Barbera V, Granata A, Otranto G et al.| title=Pulmonary Hypertension and Right Heart Failure in Chronic Kidney Disease: New Challenge for 21st-Century Cardionephrologists. | journal=Cardiorenal Med | year= 2013 | volume= 3 | issue= 2 | pages= 96-103 | pmid=23922549 | doi=10.1159/000350952 | pmc=3721135 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23922549 }} </ref> | ||
===Based on the Severity=== | ===Based on the Severity=== | ||
[[Pulmonary valve]] [[regurgitation]] is classified into three categories based on the severity into the following:<ref name="pmid20620859">{{cite journal| author=Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al.| title=Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. | journal=J Am Soc Echocardiogr | year= 2010 | volume= 23 | issue= 7 | pages= 685-713; quiz 786-8 | pmid=20620859 | doi=10.1016/j.echo.2010.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620859 }} </ref> | [[Pulmonary valve]] [[regurgitation]] is classified into three categories based on the severity into the following:<ref name="pmid20620859">{{cite journal| author=Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al.| title=Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. | journal=J Am Soc Echocardiogr | year= 2010 | volume= 23 | issue= 7 | pages= 685-713; quiz 786-8 | pmid=20620859 | doi=10.1016/j.echo.2010.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620859 }} </ref><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> | ||
{| class="wikitable" | |||
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|'''Severity'''}} | |||
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Mild}} | |||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Moderate}} | |||
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|Severe}} | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | '''Valve [[morphology]]''' | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Normal | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Normal to abnormal | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Abnormal | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" |'''[[Symptom]] status''' | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Usually [[asymptomatic]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Mild [[symptoms]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Significant [[symptoms]] | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | '''Causes''' | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Physiologic [[PR]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Secondary causes of [[PR]] <br> (such as [[pulmonary artery]] dilation) | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: center;" | Post procedure (such as valvulotomy) or <br> anatomic abnormalities of the [[valve]] | |||
|}<br /> | |||
===Other Classifications=== | |||
*According to 2018 ACHD guidelines, moderate or greater [[pulmonary valve regurgitation]] lies under ''moderate complexity'' according to ACHD (adult congenital heart disease) anatomic and physiological classification.<ref name="StoutDaniels2019">{{cite journal|last1=Stout|first1=Karen K.|last2=Daniels|first2=Curt J.|last3=Aboulhosn|first3=Jamil A.|last4=Bozkurt|first4=Biykem|last5=Broberg|first5=Craig S.|last6=Colman|first6=Jack M.|last7=Crumb|first7=Stephen R.|last8=Dearani|first8=Joseph A.|last9=Fuller|first9=Stephanie|last10=Gurvitz|first10=Michelle|last11=Khairy|first11=Paul|last12=Landzberg|first12=Michael J.|last13=Saidi|first13=Arwa|last14=Valente|first14=Anne Marie|last15=Van Hare|first15=George F.|title=2018 AHA/ACC Guideline 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 Clinical Practice Guidelines|journal=Circulation|volume=139|issue=14|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000602}}</ref> | |||
*[[Pulmonic regurgitation]] may lead to right and eventually left [[heart failure]]. New York Heart Association's (NYHA) functional classification helps to guage the severity of the [[heart failure]] via physical disability of the [[patient]]. To read more about the NYHA classification [[New york heart association functional classification|click here]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 21:52, 30 July 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
Pulmonary valve regurgitation may be classified according to pulmonary valve morphology and severity of the disease. According to the pulmonary valve morphology, it may be classified into primary and secondary or functional regurgitation. Severity of disease may classify into mild, moderate and severe disease.
Classification
Pulmonary valve regurgitation may be classified into the following types based on the etiology of the regurgitant flow and severity of the disease:[1]
Based on the Etiology
Pulmonary valve regurgitation can be classified into primary and secondary types based on the intrinsic or extrinsic factors involved in the development of the disease:
- Primary pulmonary regurgitation: The pulmonary valve morphology is affected. Isolated PR is very rare and is most commonly associated with other congenital heart diseases.[2]
- Secondary or functional pulmonary regurgitation: The pulmonary valve function is normal. Conditions such as pulmonary hypertension and pulmonary artery aneursym cause dilation of the valve annulus resulting in regurgitation.[3]
Based on the Severity
Pulmonary valve regurgitation is classified into three categories based on the severity into the following:[4][5]
| Severity | Mild | Moderate | Severe |
|---|---|---|---|
| Valve morphology | Normal | Normal to abnormal | Abnormal |
| Symptom status | Usually asymptomatic | Mild symptoms | Significant symptoms |
| Causes | Physiologic PR | Secondary causes of PR (such as pulmonary artery dilation) |
Post procedure (such as valvulotomy) or anatomic abnormalities of the valve |
Other Classifications
- According to 2018 ACHD guidelines, moderate or greater pulmonary valve regurgitation lies under moderate complexity according to ACHD (adult congenital heart disease) anatomic and physiological classification.[6]
- Pulmonic regurgitation may lead to right and eventually left heart failure. New York Heart Association's (NYHA) functional classification helps to guage the severity of the heart failure via physical disability of the patient. To read more about the NYHA classification click here.
References
- ↑ Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J. (2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 0894-7317.
- ↑ 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.
- ↑ Di Lullo L, Floccari F, Rivera R, Barbera V, Granata A, Otranto G; et al. (2013). "Pulmonary Hypertension and Right Heart Failure in Chronic Kidney Disease: New Challenge for 21st-Century Cardionephrologists". Cardiorenal Med. 3 (2): 96–103. doi:10.1159/000350952. PMC 3721135. PMID 23922549.
- ↑ Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K; et al. (2010). "Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography". J Am Soc Echocardiogr. 23 (7): 685–713, quiz 786-8. doi:10.1016/j.echo.2010.05.010. PMID 20620859.
- ↑ 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.
- ↑ Stout, Karen K.; Daniels, Curt J.; Aboulhosn, Jamil A.; Bozkurt, Biykem; Broberg, Craig S.; Colman, Jack M.; Crumb, Stephen R.; Dearani, Joseph A.; Fuller, Stephanie; Gurvitz, Michelle; Khairy, Paul; Landzberg, Michael J.; Saidi, Arwa; Valente, Anne Marie; Van Hare, George F. (2019). "2018 AHA/ACC Guideline 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 Clinical Practice Guidelines". Circulation. 139 (14). doi:10.1161/CIR.0000000000000602. ISSN 0009-7322.