Pulmonic Regurgitation Treatment & Management

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

The American Heart Association and the American College of Cardiology have published guidelines on the management of patients with valvular heart disease. [8]

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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.

Percutaneous intervention: More recently, percutaneous intervention for dysfunctional right ventricular outflow tract conduits has become available. The intermediate-term results have shown that percutaneous bioprosthetic valve implantation is a reasonable option for patients with dysfunctional right ventricular outflow tract conduits, especially those with high surgical risk. Freedom from valve dysfunction or reintervention following percutaneous bioprosthetic valve placement was 93.5% at 1 year. [9]

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Consultations

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

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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.

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