How to fix pulmonary valve regurgitation? How to treat pulmonary valve regurgitation? Let’s find out about pulmonary valve regurgitation symptoms and treatment!
Table of Contents
Pulmonary Valve Regurgitation Definition
Pulmonary valve regurgitation meaning – What is pulmonary valve regurgitation? Pulmonary regurgitation is valvulopathy that occurs when the pulmonary valve leaks during diastole. This lets blood flow backward from the pulmonary trunk into the right ventricle.
Pulmonary Valve Regurgitation Causes
What causes pulmonary valve regurgitation? What is the most common cause of pulmonary valve regurgitation?
Pulmonary valve regurgitation can be caused by high pressure (due to pulmonary hypertension) or low pressure (usually due to a dilated pulmonary annulus, a congenitally abnormal (bicuspid or dysplastic) pulmonary valve, a plaque from carcinoid disease, surgical pulmonary valve replacement, or the residual physiology after a surgical transannular patch used to reduce the outflow gradient in tetralogy of Fallot).
Since the RV can handle a load of volume better than a load of pressure, it can usually handle low-pressure pulmonary valve regurgitation for long periods without failing.
Pulmonary Valve Regurgitation Diagnosis
- Most cases are caused by high pressure on the pulmonary valve caused by pulmonary hypertension.
- In low-pressure pulmonary valve regurgitation, the echocardiogram may not be as clear-cut as in high-pressure pulmonary valve regurgitation.
- Low-pressure regurgitation of the pulmonary valve is well tolerated.
Pulmonary Valve Regurgitation Symptoms
Signs and symptoms of pulmonary valve regurgitation – What are some symptoms of pulmonary valve regurgitation?
Most patients have no signs or symptoms. However, people with severe pulmonary valve regurgitation may show signs of right heart volume overload. You can usually feel a hyperdynamic RV (RV lift) on the exam. If the PA is bigger, you may feel it along the left edge of the sternum.
P2 will be palpable in pulmonary hypertension, and sometimes both systolic and diastolic thrills will be felt. On auscultation, the second heart sound may be separated by a long RV systole or a right bundle branch block that is also present.
A pulmonary valve systolic dick and a right-sided gallop may be seen. If there is also pulmonic stenosis, the election click may weaken when you breathe in. At the same time, any systolic pulmonary murmurs will get louder. For example, the pulmonary diastolic (Graham Steell) murmur is easily heard with high-pressure pulmonary valve regurgitation. It’s often caused by a pulmonary annulus that is too big.
The murmur gets louder when the person breathes in, and it gets quieter when they do the Valsalva maneuver. In low-pressure pulmonary valve regurgitation, the PA diastolic pressure may be only a few mm Hg higher than the RV diastolic pressure, and there isn’t much diastolic gradient to cause a murmur or specific echocardiography/Doppler findings. In low-pressure pulmonary valve regurgitation, the free-flowing pulmonary valve regurgitation can sometimes only be seen with contrast angiography or MRI of the main PA.
This often happens to people who have had tetralogy of Fallot fixed. Even if there isn’t much of a murmur, there may not be a pulmonary valve. If the right ventricle is getting bigger, this could be the case.
The ECG is usually not very helpful, but the right bundle branch block is common, and there may be ECG criteria for RVH. The chest x-ray may only show that the RV and PA are getting bigger. Echocardiography can show signs of RV volume overload, such as paradoxical septal motion and an enlarged RV. Doppler can measure peak systolic RV pressure and show if there is tricuspid regurgitation.
If there is pulmonary hypertension, the interventricular septum may look like it is flattened. The size of the main PA and color flow can be set. Doppler can show the regurgitation of the pulmonary valve, especially when the pressure is high. Cardiac MRI and CT can be used to measure the size of the PA, estimate the flow of regurgitant blood, rule out other causes of pulmonary hypertension (such as thromboembolic disease or peripheral PA stenosis), and check how well the RV is working. Cardiac catheterization is only used to confirm.
Pulmonary Valve Regurgitation Treatment and Management Guidelines
Treatment of pulmonary valve regurgitation – What is the best treatment for pulmonary valve regurgitation?
Most of the time, treating the main cause of pulmonary valve regurgitation is all that is needed. However, when a surgical transannular patch repair of tetralogy of Fallot causes low-pressure pulmonary valve regurgitation, pulmonary valve replacement may be needed if the RV is enlarged or not working properly.
In tetralogy of Fallot, the QRS will get wider as RV function gets worse (a QRS longer than 180 msec, among other things, indicates a higher risk of sudden death), and an increase in RV volume should prompt a check for possible severe pulmonary valve regurgitation. In carcinoid heart disease, a porcine bioprosthesis can replace the pulmonary valve. However, the plaque that builds up from this disease eventually coats the prosthetic pulmonary valve, shortening the life of these valves. In high-pressure pulmonary valve regurgitation, controlling the cause of pulmonary hypertension is the most important part of treatment.
High-pressure pulmonary valve regurgitation is hard to deal with and is a serious condition that needs a thorough evaluation to find out what’s causing it and what kind of treatment to use. Most of the time, a bioprosthetic valve is used to replace a pulmonary valve. A percutaneous pulmonary valve can fix pulmonary valve regurgitation caused by an RV-to-PA conduit or a pulmonary autograft replacement as part of the Ross procedure (Melody valve).
A percutaneous valve has also been used to treat bioprosthetic pulmonary valve regurgitation (Edwards Sapien). When the pulmonary valve is replaced percutaneously, the PA is often stented open so that the percutaneous valve has a place to sit.
No matter the estimated pulmonary pressures, people with pulmonary valve regurgitation that causes RV enlargement should be sent to a cardiologist.
I hope you understand pulmonary valve regurgitation symptoms and treatment guidelines.