Pulmonary Regurgitation (Pulmonic Regurgitation) Differential Diagnoses

Updated: Jun 28, 2018
  • Author: Tarek Ajam, MD, MS; Chief Editor: Richard A Lange, MD, MBA  more...
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Diagnostic Considerations

As with any cardiovascular diagnosis, it is important to document the presence and extent of pulmonary or pulmonic regurgitation (PR), the treatment options considered and undertaken (including antibiotic prophylaxis for dental and other procedures), and the plans for follow-up care.

Other conditions to be considered in patients with suspected PR include the following:

  • Marfan syndrome

  • Rheumatic heart disease

  • Carcinoid heart disease

  • Aortic insufficiency: The Graham Steell murmur of pulmonary hypertension is identical in quality to that of the early diastolic murmur in aortic insufficiency. They must be differentiated.


Pregnancy is usually well tolerated in patients with PR, including those who have had surgical repairs for tetralogy of Fallot, except when right-sided heart failure is present that cannot be medically controlled.

Infective endocarditis

Pulmonic valve endocarditis is almost always associated with immunosuppressed states, intravenous/injection drug abuse, and/or congenital heart disease. The risk of endocarditis is thought to chiefly depend on two factors: the presence of high-velocity flow that injures the endothelium by shear forces or the jet impact and exposure to infective organisms. In a series of 186 patients from a congenital heart disease registry with varying degrees of pulmonary and/or tricuspid regurgitation and normal pulmonic and tricuspid valves, investigators observed that the occurrence of pulmonic and tricuspid valve endocarditis was extremely low. [15] The study, however, was not large enough to resolve the question of endocarditis risk in this group, and the authors still advised antibiotic prophylaxis against endocarditis.

The American Heart Association (AHA) recommendations on prevention of infective endocarditis do not support the necessity for antibiotic prophylaxis in pulmonic regurgitation for otherwise structurally normal pulmonic valves, especially if no diastolic murmur is audible (see Infective Endocarditis). However, PR in congenital heart malformations, acquired valvular dysfunction as in rheumatic heart disease, complex cyanotic heart disease, prosthetic valves, and prior bacterial endocarditis comprise moderate- to high–risk conditions that warrant antibiotic prophylaxis. [16, 17, 18]

Differential Diagnoses