Sandbox: Pulmonary Valve regurgitation
Overview
Historical Perspective
Epidemiology and Demographics
Classification
Pathophysiology
Causes
Congenital
Causes |
Acquired
Causes |
Chronic PR | Acute PR |
---|---|---|---|
|
|
|
Perforation of valvar pulmonary atresia |
Diagnosis
History and Symptoms
Clinical presentation of pulmonary regurgitation varies on the severity of the regurgitation and the right ventricular function.
- Isolated pulmonary regurgitation is usually asymptomatic and is an incidental finding on 2D echo even when the regurgitation is severe.
- Patients with chronic PR develop right heart failure and present with the following symptoms:
- Intitial symptom of chronic PR is functional limitation
- Ankle edema or swelling of the feet and legs
- Dyspnea on exertion
- Fatigue
- Hemoptysis or frothy sputum
- Nocturnal cough
- Palpitations or extra heart beats
Physical Examination
The physical examination findings in significant pulmonary regurgitation include:
- Soft diastolic, decrescendo murmur best heard in the left upper sternal region which increases in intensity with inspiration.
- It can accompanied by a systolic ejection murmur.
- Right ventricular heave is present when the right ventricle is enlarged.
2D Echo
2D is the the initial diagnostic investigation to diagnose PR, assess severity and the right ventricular function. The findings suggestive of PR include:
- A narrow regurgitant jet is seen in mild PR.
- In severe PR a wide diastolic jet in the RVOT is seen on colour doppler imaging. The duration of the jet increases with increasing severity of PR.
EKG
- EKG findings in chronic PR are non specific.
- In patients with tetralogy of Fallot increased QRS duration with widened QRS complex reflect the severity of PR and consequent right ventricular dilation.
Chest X-Ray
Chest X-Ray in chronic PR the following findings can be demonstrated:
- Cardiomegaly in chronic PR involving the right sided chambers.
- Pulmonary artery dilation