What Is Pulmonic Valve Regurgitation

Introduction

A pulmonary valve is a structure that has three leaflets that open and closes to transfer blood from the right ventricle of the heart to the pulmonary artery, which then takes it to the lungs, where it becomes oxygenated.

Pulmonary valve regurgitation (a.k.a pulmonic valve regurgitation) is a condition where the pulmonary valve becomes leaky. This can result in the backflow of deoxygenated blood into the heart before getting to the lungs. 

In this article, we will discuss pulmonary valve regurgitation in details, including the causes, symptoms, signs, diagnosis, treatment, prognosis, and how to live with this condition.^1,8

Causes

Pulmonary hypertension 

Pulmonary hypertension occurs when there is raised blood pressure in the blood vessels of the lungs and the right side of the heart. It is the most common cause of pulmonic valve regurgitation. There are many causes of pulmonary hypertension: high blood pressure, chronic liver disease, chronic lung disease and many more.

Congenital heart defect

The most common heart defect to cause pulmonary valve regurgitation is tetralogy of Fallot.

Infective endocarditis

It is a rare cause of pulmonary valve regurgitation. Normally occurs in cases where there is regular intravenous drug use. 

Rheumatic fever

When rheumatic fever leads to a complication of rheumatic heart disease, the chances of valvular defects increase. The pulmonary valve is the last valve to be affected. 

Other causes:

• Carcinoid syndrome
• Prosthetic heart valve
• Dilated cardiomyopathy
• Syphilis infection
• Iatrogenic (due to a medical/ surgical procedure)
• Postoperative complications following the repair of tetralogy of Fallot^1,2,8

Symptoms 

Typically, individuals with pulmonary valve regurgitation experience no symptoms as the disease is mild. Detection of this condition requires echocardiography, and it is usually conducted in symptomatic patients rather than as a routine test. Mild forms commonly occur in children or young adolescents, often stemming from congenital factors.

Moderate to severe pulmonary valve regurgitation can result in various symptoms, including: 

• Shortness of breath (on exertion or at rest)
• Tiredness (fatigue)
• Chest pain
• Lightheadedness
• Dizziness
• Palpitations (feeling your own heartbeat)
• Swelling in the legs and feet
• Syncope (falling out)³

Signs 

When a patient observes or experiences something in their own body, it is a symptom. When a healthcare provider observes something in a person’s body, it is a sign.

• Distended neck veins
• Ascites
• Pedal oedema
• Hepatosplenomegaly^3,8

Diagnosis of pulmonary valve regurgitation

It is important to contact your healthcare provider before assuming that you have this condition, as the diagnosis is based on various imaging techniques. 

Physical exam

A healthcare provider will examine your body and measure certain parameters like: 

• Pulse
• Blood pressure
• Temperature
• Pulse oximetry
• Jugular venous pressure

Both physical examination and imaging are necessary to help establish a diagnosis of this condition. 

Cardiac auscultation

A stethoscope is used to listen to heart sounds. Pulmonary valve regurgitation has a unique murmur that can be heard during cardiac auscultation. 

Cardiopulmonary exercise testing (CPET)

This test is done to determine the prognosis of the disease using a bicycle or a treadmill. It is done to determine the prognosis after confirming the disease.

Electrocardiogram (ECG)

It is a common test done when a heart anomaly is suspected. It senses the electrical impulses created during a cardiac cycle and measures them using the sensors put on the body. 

Echocardiogram 

It is an ultrasound of the heart. It uses high-frequency sound waves to create an image of the heart, its internal structure and the vessels around it. It also helps in determining the severity of the disease.

Chest X-ray

A common test is performed to look into the structures and organs present in the chest cavity. 

Cardiac MRI

A three-dimensional image of the heart. It is necessary in moderate and severe cases. 

Cardiac catheterization

Is a complex procedure used to perform various tests on the heart. It is an invasive procedure and requires an expert, specifically a cardiologist. 

Computed tomography scanning

To evaluate right heart morphology and functioning. It is used in cases where CMRI is contraindicated.^4,8

Treatment of pulmonary valve regurgitation

Mild pulmonary valve regurgitation

Most cases of pulmonary valve regurgitation are mild and do not warrant treatment. 

Moderate to severe pulmonary valve regurgitation

In the majority of cases, the treatment is focused on the cause of the disease that created this valvular defect. The goal is to reduce the load on the right side of the heart to avoid right heart failure. 

Surgical repair of the pulmonic valve is done very rarely when medical management has failed and right-sided heart failure has occurred. There can be surgical reconstruction of the valve or a replacement is done with a bioprosthetic valve (they’re preferred over mechanical valves).^5,8

Prognosis

The prognosis is dependent on the severity of the symptoms and the defect. Right heart function is an important part of evaluating the prognosis. Patients with congenital heart defects who get a surgical repair have a good prognosis. 

Mild to moderate pulmonic valve regurgitation is generally asymptomatic; hence, it doesn’t affect the chances of survival. 

As with most diseases, early diagnosis, treatment, adherence to medications, and regular follow-up are essential for good results.^8,3

Living with pulmonary valve regurgitation

• Take the medications as provided by your healthcare provider according to the underlying cause that created the pulmonic valve defect
• People with bioprosthesis need to take regular oral anticoagulation to avoid thrombosis and embolism
•  In the case of infective endocarditis, the patient should take their antibiotics as prescribed
• Vasodilator therapies can also be used if necessary
• A salt-restriction diet benefits most people. Contact your healthcare provider for more information about your specific case
• Physical activity can be performed as advised by the doctor, as it can vary from person to person
• Regular follow-up with a doctor is important to assess the disease. Observe how you feel and try to give your doctor an elaborate history^6,8

FAQs

Can I determine if I have pulmonary valve regurgitation based on my symptoms?

No, the diagnosis is confirmed with multiple imaging techniques performed by a healthcare practitioner. The symptoms can be vague and they don't necessarily conclude anything.^7,8

Is pulmonary valve regurgitation reversible?

Individuals can lead a relatively unaffected life with pulmonary valve regurgitation. It can be cured, but that depends on the disease's progression and severity. 

How does pulmonary valve regurgitation impact pregnancy?

In most cases, mild pulmonary valve regurgitation does not significantly impact pregnancy. However, as each case is unique, individuals should consult their healthcare provider for a more accurate understanding of their specific condition.

When is it necessary to go to the emergency room?

Persistent discomfort that lasts for a long period without improvement warrants a visit to the emergency room. This includes but is not limited to severe palpitations, episodes of fainting, breathlessness, chest pain, fever, swelling in any part of the body, and extreme dizziness.

Can I prevent this condition from happening? 

It is generally unpredictable, so it is impossible to prevent it in most cases. In some cases, using prophylactic antibiotics to prevent infective endocarditis in high-risk situations may offer some inadvertent assistance. 

Is pulmonary valve regurgitation contagious? 

No, it is not an infectious disease.

Summary

To summarize, pulmonary valve regurgitation is a condition where the pulmonary valve becomes leaky, allowing the backflow of deoxygenated blood into the heart. The causes include pulmonary hypertension, congenital heart defects, infective endocarditis, rheumatic fever, and various other factors. Symptoms can range from none to severe, and diagnosis involves physical exams and various imaging techniques.

Treatment approaches differ based on the severity, with mild cases often requiring no intervention. For moderate to severe cases, addressing the underlying cause is prioritized, and surgical repair may be considered in rare instances. Prognosis is influenced by symptom severity and right heart function. Living with pulmonary valve regurgitation involves medication adherence, lifestyle adjustments, and regular follow-ups for optimal management.