Definition and Overview

Pulmonary regurgitation (PR) is a condition that describes a leaking pulmonary valve. The pulmonary valve is one of the heart’s four valves. The other three are the mitral, aortic, and tricuspid valves. Each plays a crucial role in proper blood circulation. With each heartbeat, these valves open up, allowing blood to flow forward. They then close tightly to prevent blood from flowing backward. PR occurs when the flaps of the pulmonary valve are not closing properly. This causes the blood to flow back into the right ventricle instead of flowing out to the lungs.

The condition is very common. According to statistics, more than 90% of the population has mild to moderate cases of the condition. But because it often does not produce symptoms, many remain undiagnosed. Many cases are accidentally found when patients undergo medical tests for unrelated health problems. Many patients with PR are able to lead normal lives.

Causes of Condition

The most common causes of PR are heart defects that are present at birth and pulmonary hypertension (PHT). PHT refers to persistent high blood pressure in the arteries to the lungs. It forces the heart to work harder in order to push the blood through. Heart defects that are present at birth, on the other hand, are abnormalities that affect the walls and valves of the heart. These defects can also affect the arteries and veins near the organ. A number of PR cases are attributed to tetralogy of Fallot. This is a rare, complex heart defect. It causes deoxygenated blood to flow out of the heart and the rest of the body.

Less common causes of the condition are the following:

  • Infective endocarditis - This infection is caused by bacteria that have travelled to the heart through the bloodstream. The bacteria can settle in the pulmonary valve or in the heart lining.

  • Pulmonary valve problems - Some patients are born with a thickened, malformed, or narrowed pulmonary valve. This limits the amount of blood that flows through the valve. In very rare cases, the valve is either poorly formed or missing.

  • Complications of heart procedures - PR can be a complication of some medical procedures. An example is balloon valvuloplasty that is meant to widen a narrowed pulmonary valve. The valve can also be damaged during a heart surgery meant to correct certain types of heart defects.

Key Symptoms

Many patients with PR do not show any signs of the condition. In such cases, PR is not a cause for concern. However, those with severe cases often suffer from fatigue, shortness of breath, and persistent chest pain. Other symptoms include abnormal heartbeats and fainting. When patients undergo a routine physical examination, doctors hear a certain type of murmur when they listen to the patient’s heartbeat using a stethoscope. A murmur is an unusual sound that occurs between heartbeats. It sounds like a swishing or whooshing noise. It is a sign of a problem in blood circulation.

Who to See and Treatment Available

Patients showing symptoms of the condition often go to their primary doctor for an initial assessment. If their doctor suspects heart-related problems, they are referred to heart specialists (cardiologists).

Diagnosing the condition starts with a physical examination. The heart specialist will listen to the patient’s heartbeat using a stethoscope. A heart murmur is usually the first sign that the patient has PR. The doctor will also review the patient’s medical history. He or she would want to know if there is a family history of heart disease and/or pulmonary hypertension.

Tests used to confirm PR include a Doppler echocardiography (ECG). This is a standard test used in cardiology (heart care). It uses ultrasound technology to assess the health of the heart and its blood vessels. It creates an image of the heart and allows doctors to determine the speed and direction of blood flow. The test is painless. It is very useful because it can detect even a small amount of valve leakage. The test also helps the doctor assess the condition of the right ventricle. It can confirm if the right ventricle is enlarged or thickened. In patients with severe cases of PR, magnetic resonance imaging (MRI) can also be used. This test helps doctors determine if there is a need for surgery.

Treatment of PR is directed at its cause. Treatment options include medical therapy and certain procedures. An example is balloon valvuloplasty for those with a narrowed pulmonary valve. Patients with mild cases may not require treatment. However, their condition may be monitored with periodic ECGs to ensure that it is not progressing.

In very rare cases, pulmonary valve replacement is carried out. In this procedure, the diseased pulmonary valve is removed and replaced. Doctors may use a biological or mechanical valve made from artificial materials. The procedure can be performed via open-heart surgery. This requires an incision in the chest wall. It can also be carried out using a less invasive technique that uses several small incisions. This method minimises the many risks of open surgery. However, its success largely depends on the skill, experience, and expertise of the surgeon.

The prognosis for patients with severe PR depends on a number of factors. These include the underlying disease, if other valves are also damaged, and how soon the patient received treatment.

References:

  • Types of replacement heart valves. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Types-of-Replacement-Heart-Valves_UCM_451175_Article.jsp#.WBjnUWXT8lY.

  • Single ventricle defects. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Single-Ventricle-Defects_UCM_307037_Article.jsp#.WCyKrWVNwlZ.

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