Pulmonic regurgitation pathophysiology

	Pulmonic regurgitation Microchapters
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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]

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

Stage	Definition	Pulmonary Valve Anatomy	Valve Hemodynamics	Hemodynamic Consequences	Symptoms
C,D	Severe Pulmonary valve regurgitation	Distorted or absent leaflets Annular dilation	Color jet fills right ventricular outlet tract CW jet density and contour: dense laminar flow with steep deceleration slope; may terminate abruptly	Paradoxical septal motion (volume overload pattern) Right ventricular enlargement	None or variable and dependent on cause of pulmonary reguritation and right ventricular function

v t e Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747)
Cardiac chambers and connections	Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo)
Cardiac septa	Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome
Right: pulmonary and tricuspid valves	pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly
Left: aortic and mitral valves	aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome
Other congenital malformations of heart	Dextrocardia - Levocardia - Cor triatriatum
Great arteries	aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia
Great veins	Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome
Other	Arteriovenous malformation (Cerebral arteriovenous malformation)
See also non-congenital conditions (I, 390-459)