eMedicine Specialties > Cardiology > Valvular Heart Disease

Pulmonic Regurgitation: Treatment & Medication

Author: Xiushui (Mike) Ren, MD, Clinical Echocardiography Fellow, Division of Cardiology, University of California, San Francisco; Clinical Cardiology Fellow, Division of Cardiology, California Pacific Medical Center
Coauthor(s): Pablo J Saavedra, MD, Fellow, Department of Cardiology, Vanderbilt University School of Medicine; 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
Contributor Information and Disclosures

Updated: Apr 17, 2008

Treatment

Medical Care

Pulmonic regurgitation is seldom severe enough to warrant special treatment because the right ventricle normally adapts to low-pressure volume overload without difficulty. High-pressure volume overload leads to right-sided heart strain and, ultimately, heart failure.

Underlying etiologies causing severe pulmonic regurgitation, whether congenital or acquired, must be treated to prevent or reverse right-sided heart strain and failure that may further complicate the clinical picture. A discussion of therapeutic interventions in pulmonary hypertension by etiology is beyond the scope of this article. Refer to the articles for each entity under Differentials for a detailed discussion of treatment options.

  • If pulmonary hypertension is identified with pulmonic regurgitation, determining the etiology is essential to institute appropriate therapy as expeditiously as possible. For instance, primary pulmonary hypertension, secondary pulmonary hypertension due to thromboembolism, severe mitral stenosis, and pulmonary carcinomatosis can all manifest as severe pulmonary hypertension with pulmonic regurgitation.
  • No aspect of medical management of heart failure is uniquely applicable to pulmonic regurgitation, and the discussion of management of right-sided heart failure is beyond the scope of this article. In general, similar approaches to those used in the treatment of patients with left-sided congestive heart failure can be useful. In some circumstances, such as in patients with pulmonary hypertension, vasodilator therapies must be very carefully considered and monitored. In addition, therapies aimed toward the underlying etiology may also reduce pulmonic regurgitation (see Heart Failure).

Surgical Care

  • When right-sided heart failure due to pulmonic regurgitation from an abnormal pulmonic valve cannot be ameliorated by medical management, appropriate options include surgical reconstruction or replacement of the pulmonic valve, preferably with a bioprosthetic valve.
  • Although congenital pulmonic regurgitation is usually well tolerated, the much more rare congenital absence of the pulmonic valve usually requires valve replacement.

Consultations

Consider consultation with cardiologists for patients with right-sided heart failure in the presence of severe pulmonic regurgitation.

Activity

Since pulmonic regurgitation is usually of a mild-to-moderate degree, restriction of athletic activities is unnecessary. Follow-up echocardiographic studies can provide data to assess for changes in pulmonic regurgitation and right ventricular functional status in order to more objectively base activity limitation recommendations.

Medication

Medications are directed according to the specific etiology resulting in pulmonic regurgitation in addition to the treatment of heart failure (if present). Complete discussions regarding medication use in the specific etiologies noted above may be found in the respective eMedicine articles (see Heart Failure). Infective endocarditis antibiotic prophylaxis should be considered for patients whose pulmonic regurgitation is due to valve leaflet abnormalities.

More on Pulmonic Regurgitation

Overview: Pulmonic Regurgitation
Differential Diagnoses & Workup: Pulmonic Regurgitation
Treatment & Medication: Pulmonic Regurgitation
Follow-up: Pulmonic Regurgitation
References
[ CLOSE WINDOW ]

References

  1. Pellikka PA, Tajik AJ, Khandheria BK, Seward JB, Callahan JA, Pitot HC, et al. Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients. Circulation. Apr 1993;87(4):1188-96. [Medline].

  2. Dodo H, Perloff JK, Child JS, et al. Are high-velocity tricuspid and pulmonary regurgitation endocarditis risk substrates?. Am Heart J. Jul 1998;136(1):109-14. [Medline].

  3. Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ. Echocardiographic determination of mean pulmonary artery pressure. Am J Cardiol. Dec 1 2003;92(11):1373-6. [Medline].

  4. Anderson AS, Krauss D, Lang R. Cardiovascular complications of malignant carcinoid disease. Am Heart J. Oct 1997;134(4):693-702. [Medline].

  5. Babu-Narayan SV, Kilner PJ, Li W, Moon JC, Goktekin O, Davlouros PA, et al. Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of fallot and its relationship to adverse markers of clinical outcome. Circulation. Jan 24 2006;113(3):405-13. [Medline].

  6. Borgeson DD, Seward JB, Miller FA Jr, Oh JK, Tajik AJ. Frequency of Doppler measurable pulmonary artery pressures. J Am Soc Echocardiogr. Nov-Dec 1996;9(6):832-7. [Medline].

  7. Bossone E, Duong-Wagner TH, Paciocco G, et al. Echocardiographic features of primary pulmonary hypertension. J Am Soc Echocardiogr. Aug 1999;12(8):655-62. [Medline].

  8. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. First of two parts. N Engl J Med. Jan 27 2000;342(4):256-63. [Medline].

  9. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. Second of two parts. N Engl J Med. Feb 3 2000;342(5):334-42. [Medline].

  10. Chowdhury UK, Pradeep KK, Patel CD, Singh R, Kumar AS, Airan B, et al. Noninvasive assessment of repaired tetralogy of Fallot by magnetic resonance imaging and dynamic radionuclide studies. Ann Thorac Surg. Apr 2006;81(4):1436-42. [Medline].

  11. Conte S, Jashari R, Eyskens B, et al. Homograft valve insertion for pulmonary regurgitation late after valveless repair of right ventricular outflow tract obstruction. Eur J Cardiothorac Surg. Feb 1999;15(2):143-9. [Medline].

  12. Dajani AS, Taubert KA, Wilson W, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation. Jul 1 1997;96(1):358-66. [Medline].

  13. Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A Textbook of Cardiovascular Medicine. 2001. 6th ed. W B Saunders Co.

  14. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. Aug 15 1990;66(4):493-6. [Medline].

  15. Lipton MJ, Coulden R. Valvular heart disease. Radiol Clin North Am. Mar 1999;37(2):319-39, v-vi. [Medline].

  16. Miller-Hance WC, Silverman NH. Transesophageal echocardiography (TEE) in congenital heart disease with focus on the adult. Cardiol Clin. Nov 2000;18(4):861-92. [Medline].

  17. Nagueh SF. Assessment of valvular regurgitation with Doppler echocardiography. Cardiol Clin. Aug 1998;16(3):405-19, vii. [Medline].

  18. Perloff Joseph K, Child JS. Congenital Heart Disease in Adults. 2nd ed. W B Saunders Co; 1998.

  19. Ristow B, Ahmed S, Wang L, Liu H, Angeja BG, Whooley MA. Pulmonary regurgitation end-diastolic gradient is a Doppler marker of cardiac status: data from the Heart and Soul Study. J Am Soc Echocardiogr. Sep 2005;18(9):885-91. [Medline].

  20. Ristow B, Ali S, Ren X, Whooley MA, Schiller NB. Elevated pulmonary artery pressure by Doppler echocardiography predicts hospitalization for heart failure and mortality in ambulatory stable coronary artery disease: the Heart and Soul Study. J Am Coll Cardiol. Jan 2 2007;49(1):43-9. [Medline].

  21. Rosenkranz ER. Caring for the former pediatric cardiac surgery patient. Pediatr Clin North Am. Aug 1998;45(4):907-41. [Medline].

  22. Schiller NB. Hemodynamics derived from transesophageal echocardiography (TEE). Cardiol Clin. Nov 2000;18(4):699-709. [Medline].

  23. Shively BK. Transesophageal echocardiographic (TEE) evaluation of the aortic valve, left ventricular outflow tract, and pulmonic valve. Cardiol Clin. Nov 2000;18(4):711-29. [Medline].

  24. Sorrell VL, Altbach MI, Kudithipudi V, Squire SW, Goldberg SJ, Klewer SE. Cardiac MRI is an important complementary tool to Doppler echocardiography in the management of patients with pulmonary regurgitation. Echocardiography. Mar 2007;24(3):316-28. [Medline].

  25. Teerlink JR, Foster E. Valvular heart disease in pregnancy. A contemporary perspective. Cardiol Clin. Aug 1998;16(3):573-98, x. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

pulmonary regurgitation, tricuspid regurgitation, pulmonic insufficiency, pulmonary insufficiency, right ventricle, right ventricular outflow, retrograde flow, right-sided volume overload, heart failure, pulmonary hypertension, dilated cardiomyopathy, connective-tissue disease, infective endocarditis, carcinoid heart disease, rheumatic heart disease, pulmonary hypertension, Graham Steell murmur, Marfan syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Xiushui (Mike) Ren, MD, Clinical Echocardiography Fellow, Division of Cardiology, University of California, San Francisco; Clinical Cardiology Fellow, Division of Cardiology, California Pacific Medical Center
Xiushui (Mike) Ren, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, and American Society of Echocardiography
Disclosure: Nothing to disclose.

Coauthor(s)

Pablo J Saavedra, MD, Fellow, Department of Cardiology, Vanderbilt University School of Medicine
Pablo J Saavedra, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

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, and Rhode Island Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marschall S Runge, MD, PhD, Charles and Anne Sanders Distinguished Professor of Medicine, Chairman of Medicine, Vice Dean for Clinical Affairs, Chairman, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association
Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, Professor and Executive Vice Chairman of Medicine
Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.