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Pulmonary regurgitation: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Pulmonary regurgitation is a failure of the pulmonary artery valve, which causes blood flow from the pulmonary artery to the right ventricle during diastole. The most common cause is pulmonary arterial hypertension. Pulmonary regurgitation is usually asymptomatic. Its sign is a diminishing diastolic noise. The diagnosis is established echocardiographically. Usually no specific treatment is required, except for the therapy of conditions that cause pulmonary arterial hypertension.
Secondary pulmonary arterial hypertension is the most common cause of pulmonary regurgitation. Rarely, infectious endocarditis, surgical treatment of Fallot tetrad, idiopathic dilatation of the pulmonary artery and congenital pathology of the valve become the causes. Carcinoid syndrome, rheumatic fever, syphilis and trauma to the probe are rare causes. Severe pulmonary regurgitation is rare and is most often the result of an isolated congenital defect, including pulmonary artery enlargement and pulmonary valve rings.
Pulmonary regurgitation can contribute to the development of right ventricular hypertrophy and ultimately induced by right ventricular dysfunction of heart failure (HF), but in most cases the significance of pulmonary arterial hypertension in the development of this complication is much more significant. Rarely, acute heart failure caused by right ventricular dysfunction develops with endocarditis, leading to acute pulmonary regurgitation.
Symptoms of pulmonary regurgitation
Pulmonary regurgitation is usually asymptomatic. Some patients develop symptoms of heart failure caused by right ventricular dysfunction.
Palpable features reflect pulmonary arterial hypertension and right ventricular hypertrophy. They include the sensory pulmonary component (P) of the II heart tone (S 2) at the upper left edge of the sternum and the pronounced right ventricular pulsation, which is increased in amplitude, at the left edge of the sternum at the middle and lower levels.
With auscultation, I heart tone (S1)normal. S1 can be split or single. If it is cleaved, P can be loud, audible right after the aortic component of S (A due to pulmonary arterial hypertension, and P can be delayed due to increased right ventricular stroke volume.) S may be single due to rapid closure of the pulmonary artery valve, coinciding with the fusion components A and P, or (sometimes) due to the congenital absence of the pulmonary valve. The right ventricular heart rate (S3), the IV heart tone (S4), or both tones can be audible with heart failure due to dysfunction and and right ventricular hypertrophy. These tones can be distinguished from left ventricular heart sounds as they are heard on the left parasternal in the fourth intercostal space and amplified on inspiration.
The noise of pulmonary regurgitation due to pulmonary arterial hypertension is a high-frequency early diastolic diminishing noise that starts from P, continues to S and is carried to the middle of the right edge of the sternum (Graham Still's noise). It is heard best at the left upper edge of the sternum through a stethoscope with a diaphragm, when the patient holds his breath while exhaling and sits straight. The noise of pulmonary regurgitation without pulmonary arterial hypertension is shorter, a lower tone (more coarse) and begins after R. Both noise may resemble the noise of aortic regurgitation, but they can be distinguished by inspiration (which increases the noise of pulmonary regurgitation) and the Valsalva test. In the latter case, the noise of pulmonary regurgitation immediately becomes loud (due to an immediate increase in the venous inflow to the right heart), and AP noise is increased through 4-5 heartbeats. In addition, the mild noise of pulmonary regurgitation can sometimes become even softer on inspiration, as this noise is usually best heard in the second intercostal space to the left, where the inspiration pushes the stethoscope away from the heart.
Diagnosis of pulmonary regurgitation
Pulmonary regurgitation is usually detected by chance during a physical examination or Doppler echocardiography performed for other reasons. Assign ECG and chest X-ray. Both methods can demonstrate signs of right ventricular hypertrophy. Chest X-ray usually reveals the conditions underlying pulmonary arterial hypertension.
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Treatment of pulmonary regurgitation
Treatment involves the therapy of a condition that causes pulmonary regurgitation. Prosthetics of the pulmonary artery valve is the method of choice for the development of heart failure due to right ventricular dysfunction, but the results and the degree of risk are unclear, since the need for prosthetics arises rarely.