Pulmonic Regurgitation Follow-up
- Author: Xiushui (Mike) Ren, MD; Chief Editor: Richard A Lange, MD, MBA more...
Further Outpatient Care
Regurgitation may worsen with time. Therefore, periodic echocardiographic reassessment with Doppler color flow studies provides a longitudinal comparison of the progression of both the regurgitation and right ventricular size and function. In cases of significant pulmonic regurgitation, exercise capacity should be assessed and quantitated serially, observing for a change or decrease in function, the goal being to accurately assess the need and potential timing for surgical repair.
Further Inpatient Care
Aspects of inpatient care are primarily governed by the treatment indicated for the particular disorder that causes pulmonic regurgitation. As previously mentioned, if heart failure is present that is due to or exacerbated by pulmonic regurgitation, usual heart failure management applies.
Transfer requirements are the same as in heart failure.
Specific comments on deterrence and prevention of pulmonic regurgitation in general are not found in the literature, except in the context of the specific entities, such as those listed in Causes, that can cause pulmonic regurgitation.
Periodic echocardiographic follow-up is appropriate when significant pulmonic regurgitation is present in order to better manage the condition over the long term and to help decide when interventions may be warranted.
Right-sided heart failure is a complication of volume overload of the right ventricle due to severe pulmonic regurgitation.
Other complications are related to the underlying disease processes resulting in pulmonic regurgitation.
In general, survival is not significantly affected by mild-to-moderate pulmonic regurgitation. If pulmonic regurgitation is severe, the right ventricle is initially able to compensate for the volume overload state, and the state may remain well compensated for years. Persistently elevated right ventricular volumes may eventually cause right ventricular dilatation, and, finally, failure.
As previously stated, the various disorders causing pulmonary hypertension are the most common causes of clinically significant pulmonic regurgitation. The principal prognostic indicators of mortality in pulmonic regurgitation associated with pulmonary hypertension are (1) the severity and duration of the pulmonary hypertension at the time of diagnosis and (2) the right ventricular response to the state of volume overload.
In all etiologies of pulmonary hypertension, early diagnosis that allows for intervention to slow or reverse the cause of pulmonary hypertension is essential, although, in many cases, diagnosis is difficult and requires a high degree of clinical suspicion.
In primary pulmonary hypertension, the pathologic process is often insidious, and symptoms manifest at an advanced disease state, resulting in an average survival period of 2.5 years from the time of diagnosis.
In congenital regurgitation of the pulmonic valve, the prognosis depends upon the initial severity, progression of the regurgitation, and the ability of the right ventricle to adapt to volume overload. Usually, the degree of regurgitation in this condition is no more than moderate, so no clinical sequelae occur. Congenital absence of the pulmonic valve, a much rarer condition, confers an increased risk of morbidity and mortality because of more severe regurgitation and usually warrants pulmonic valve replacement for improved prognosis.
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