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Pulmonic Regurgitation Follow-up

  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Richard A Lange, MD, MBA  more...
 
Updated: Feb 17, 2015
 

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.

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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.

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Transfer

Transfer requirements are the same as in heart failure.

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Deterrence/Prevention

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.

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Complications

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.

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Prognosis

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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Contributor Information and Disclosures
Author

Xiushui (Mike) Ren, MD Cardiologist, The Permanente Medical Group; Associate Director of Research, Cardiovascular Diseases Fellowship, California Pacific Medical Center

Xiushui (Mike) Ren, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Society of Echocardiography

Disclosure: Nothing to disclose.

Coauthor(s)

Lauralyn B Cannistra, MD, FACC Director of Echocardiography Lab and Cardiac Rehabilitation, Assistant Professor, Department of Medicine, Memorial Hospital of Rhode Island, Brown University School of Medicine

Lauralyn B Cannistra, MD, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Anesthesiologists, American Society of Echocardiography, Rhode Island Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author Pablo J Saavedra, MD, to the development and writing of this article.

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