Pulmonic regurgitation causes

	Pulmonic regurgitation Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]

Overview

A small amount of pulmonic regurgitation is normal and occasionally can be heard in thin subjects. Pathologic pulmonic regurgitation is most frequently a result of pulmonary hypertension (Graham-Steell murmur) or residual after Tetralogy of Fallot repair in adults.

Causes

The most common causes of pulmonary regurgitation are following repair of tetralogy of Fallot and pulmonary stenosis. Other common causes include as follows:^[1]^[2]^[3]^[4]

Congenital Causes	Acquired Causes	Chronic PR	Acute PR
Quadricuspid or Bicuspid valves Hypoplasia of the valves Prolapse of the pulmonary valve	Infective endocarditis Following transannular patching for tetralogy of Fallot Post repair of pulmonary valve stenosis Rheumatic heart disease Carinoid Syndrome Myxomatous Degeneration of the pulmonary valve.	Following transannular patching for tetralogy of Fallot Following balloon or surgical valvulotomy or valvuloplasty for pulmonary stenosis Absent pulmonary valve syndrome Isolated congenital PR Peripheral pulmonary artery stenosis Pulmonary hypertension Right ventricular outlet aneurysm	Neonatal Ebstein’s anomaly Following balloon dilation of critical pulmonary stenosis Perforation of valvar pulmonary atresia

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular	Congenital heart disease, dilated cardiomyopathy, Eisenmenger syndrome, endocarditis, infective endocarditis, myocardial rupture, patent ductus arteriosus, rheumatic heart disease, right ventricular tumors
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Cabergoline, ergotamine, fenfluramine, fluoxetine, methysergide, paroxetine, pergolide, phentermine, sertraline
Ear Nose Throat	No underlying causes
Endocrine	Carcinoid syndrome
Environmental	Pneumoconiosis
Gastroenterologic	No underlying causes
Genetic	Mucopolysaccharidoses, patent ductus arteriosus, polycystic kidney disease, X-linked dilated cardiomyopathy
Hematologic	No underlying causes
Iatrogenic	Balloon valvuloplasty of the pulmonary valve, cardiac catheterization, cardiopulmonary resuscitation, heart surgery, pacemaker syndrome, percutaneous coronary intervention, prosthetic valve dysfunction, Tetralogy of Fallot repair
Infectious Disease	Infective endocarditis, myocarditis, rheumatic fever
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Carcinoid syndrome
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Cor pulmonale, idiopathic pulmonary fibrosis, Langerhans cell histiocytosis, pneumoconiosis, pulmonary hypertension, sarcoidosis
Renal/Electrolyte	End stage renal disease, polycystic kidney disease
Rheumatology/Immunology/Allergy	Rheumatic fever, sarcoidosis
Sexual	No underlying causes
Trauma	Blunt or penetrating chest trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

References

↑ Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P; et al. (2001). "Long-term results after early primary repair of tetralogy of Fallot". J Thorac Cardiovasc Surg. 122 (1): 154–61. doi:10.1067/mtc.2001.115156. PMID 11436049.
↑ Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS (2016). "Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI)". J Thorac Imaging. 31 (1): W4–12. doi:10.1097/RTI.0000000000000182. PMID 26656195.
↑ Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D; et al. (2015). "Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future". J Am Coll Cardiol. 66 (20): 2246–55. doi:10.1016/j.jacc.2015.09.055. PMID 26564602.
↑ 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.
↑ Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J (2009). "Drug-induced fibrotic valvular heart disease". Lancet. 374 (9689): 577–85. doi:10.1016/S0140-6736(09)60252-X. PMID 19683643.
↑ Sharma S, Kirpalani AL, Kulkarni A (2010). "Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis". Ann Pediatr Cardiol. 3 (2): 184–6. doi:10.4103/0974-2069.74055. PMC 3017928. PMID 21234203.
↑ Hendrikx M, Van Dorpe J, Flameng W, Daenen W (1996). "Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature". J Heart Valve Dis. 5 (2): 235–7. PMID 8665020.
↑ Wilke A, Hesse H, Hufnagel G, Maisch B (1997). "Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine". Eur Heart J. 18 (4): 701. PMID 9129909.
↑ Nadrous HF, Pellikka PA, Krowka MJ, Swanson KL, Chaowalit N, Decker PA; et al. (2005). "Pulmonary hypertension in patients with idiopathic pulmonary fibrosis". Chest. 128 (4): 2393–9. doi:10.1378/chest.128.4.2393. PMID 16236900.
↑ Chaowalit N, Pellikka PA, Decker PA, Aubry MC, Krowka MJ, Ryu JH; et al. (2004). "Echocardiographic and clinical characteristics of pulmonary hypertension complicating pulmonary Langerhans cell histiocytosis". Mayo Clin Proc. 79 (10): 1269–75. doi:10.4065/79.10.1269. PMID 15473409.
↑ Bana DS, MacNeal PS, LeCompte PM, Shah Y, Graham JR (1974). "Cardiac murmurs and endocardial fibrosis associated with methysergide therapy". Am Heart J. 88 (5): 640–55. PMID 4420941.
↑ Nelson J, Shields MD, Mulholland HC (1990). "Cardiovascular studies in the mucopolysaccharidoses". J Med Genet. 27 (2): 94–100. PMC 1016928. PMID 2108248.
↑ Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE (2002). "Valvular heart disease in patients taking pergolide". Mayo Clin Proc. 77 (12): 1280–6. doi:10.4065/77.12.1280. PMID 12479512.
↑ Adeva M, El-Youssef M, Rossetti S, Kamath PS, Kubly V, Consugar MB; et al. (2006). "Clinical and molecular characterization defines a broadened spectrum of autosomal recessive polycystic kidney disease (ARPKD)". Medicine (Baltimore). 85 (1): 1–21. doi:10.1097/01.md.0000200165.90373.9a. PMID 16523049.
↑ Arkles JS, Opotowsky AR, Ojeda J, Rogers F, Liu T, Prassana V; et al. (2011). "Shape of the right ventricular Doppler envelope predicts hemodynamics and right heart function in pulmonary hypertension". Am J Respir Crit Care Med. 183 (2): 268–76. doi:10.1164/rccm.201004-0601OC. PMID 20709819.
↑ Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004). "Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging". J Am Coll Cardiol. 43 (6): 1068–74. doi:10.1016/j.jacc.2003.10.045. PMID 15028368.

[pmid11436049-1] Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P; et al. (2001). "Long-term results after early primary repair of tetralogy of Fallot". J Thorac Cardiovasc Surg. 122 (1): 154–61. doi:10.1067/mtc.2001.115156. PMID 11436049.

[pmid26656195-2] Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS (2016). "Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI)". J Thorac Imaging. 31 (1): W4–12. doi:10.1097/RTI.0000000000000182. PMID 26656195.

[pmid26564602-3] Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D; et al. (2015). "Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future". J Am Coll Cardiol. 66 (20): 2246–55. doi:10.1016/j.jacc.2015.09.055. PMID 26564602.

[pmid18997168-4] 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.

[pmid19683643-5] Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J (2009). "Drug-induced fibrotic valvular heart disease". Lancet. 374 (9689): 577–85. doi:10.1016/S0140-6736(09)60252-X. PMID 19683643.

[pmid21234203-6] Sharma S, Kirpalani AL, Kulkarni A (2010). "Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis". Ann Pediatr Cardiol. 3 (2): 184–6. doi:10.4103/0974-2069.74055. PMC 3017928. PMID 21234203.

[pmid8665020-7] Hendrikx M, Van Dorpe J, Flameng W, Daenen W (1996). "Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature". J Heart Valve Dis. 5 (2): 235–7. PMID 8665020.

[pmid9129909-8] Wilke A, Hesse H, Hufnagel G, Maisch B (1997). "Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine". Eur Heart J. 18 (4): 701. PMID 9129909.

[pmid16236900-9] Nadrous HF, Pellikka PA, Krowka MJ, Swanson KL, Chaowalit N, Decker PA; et al. (2005). "Pulmonary hypertension in patients with idiopathic pulmonary fibrosis". Chest. 128 (4): 2393–9. doi:10.1378/chest.128.4.2393. PMID 16236900.

[pmid15473409-10] Chaowalit N, Pellikka PA, Decker PA, Aubry MC, Krowka MJ, Ryu JH; et al. (2004). "Echocardiographic and clinical characteristics of pulmonary hypertension complicating pulmonary Langerhans cell histiocytosis". Mayo Clin Proc. 79 (10): 1269–75. doi:10.4065/79.10.1269. PMID 15473409.

[pmid4420941-11] Bana DS, MacNeal PS, LeCompte PM, Shah Y, Graham JR (1974). "Cardiac murmurs and endocardial fibrosis associated with methysergide therapy". Am Heart J. 88 (5): 640–55. PMID 4420941.

[pmid2108248-12] Nelson J, Shields MD, Mulholland HC (1990). "Cardiovascular studies in the mucopolysaccharidoses". J Med Genet. 27 (2): 94–100. PMC 1016928. PMID 2108248.

[pmid12479512-13] Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE (2002). "Valvular heart disease in patients taking pergolide". Mayo Clin Proc. 77 (12): 1280–6. doi:10.4065/77.12.1280. PMID 12479512.

[pmid16523049-14] Adeva M, El-Youssef M, Rossetti S, Kamath PS, Kubly V, Consugar MB; et al. (2006). "Clinical and molecular characterization defines a broadened spectrum of autosomal recessive polycystic kidney disease (ARPKD)". Medicine (Baltimore). 85 (1): 1–21. doi:10.1097/01.md.0000200165.90373.9a. PMID 16523049.

[pmid20709819-15] Arkles JS, Opotowsky AR, Ojeda J, Rogers F, Liu T, Prassana V; et al. (2011). "Shape of the right ventricular Doppler envelope predicts hemodynamics and right heart function in pulmonary hypertension". Am J Respir Crit Care Med. 183 (2): 268–76. doi:10.1164/rccm.201004-0601OC. PMID 20709819.

[pmid15028368-16] Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004). "Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging". J Am Coll Cardiol. 43 (6): 1068–74. doi:10.1016/j.jacc.2003.10.045. PMID 15028368.

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