Pulmonary regurgitation occurs when the pulmonary valve doesn’t function properly, causing blood to flow back into the right ventricle. Symptoms include difficulty breathing, fatigue, and heart murmurs. Treatment options include monitoring, medication, and surgery. People with this condition are more vulnerable to bacterial endocarditis.
Pulmonary or pulmonary regurgitation is a heart condition that suggests that the pulmonary valve isn’t doing its job efficiently. The valve’s function is to open and close, allowing blood to pass into the pulmonary artery, then into the lungs. If this valve, which is attached to the right ventricle, is compromised in any way, it may not close properly and blood will flow back into the right ventricle. Over time, the right ventricle can enlarge and pump less efficiently, and people can experience many symptoms that can ultimately lead to right heart failure.
There are many potential causes of pulmonary regurgitation. A number of congenital heart defects that are large or small can show some degree of this symptom. Even repairs of complex heart defects can leave a residual and acceptable amount of regurgitation, and some repairs, such as pulmonary valve replacements as they get older, can show increasingly higher levels of this. Other causes of regurgitation, more often seen in adults, include pulmonary hypertension or bacterial endocarditis.
The symptom of mild forms of pulmonary regurgitation may be non-existent, or so minor as to elude detection. As the condition worsens, the symptoms become more apparent. They may include cyanosis (blue, especially of the extremities), difficulty breathing, fatigue, fluid accumulation in places such as the ankles and possibly the abdomen, and a distinct, detectable heart murmur.
To better diagnose this condition, cardiologists usually perform a variety of tests. An echocardiogram easily shows blood leaking into the right ventricle. X-rays can indicate any fluid buildup. An electrocardiogram (ECG) is useful for detecting heart rhythm problems associated with pulmonary regurgitation. Another test that may be used is cardiac catheterization, which can also measure the level of pulmonary hypertension if it is a causal factor.
There are several ways to treat pulmonary regurgitation, and treatment depends on the underlying cause and severity. Very minor cases may be monitored just to see if they get worse. Some medications can be used to minimize heart failure symptoms and improve right heart function. The other option is surgery, which means repairing or replacing the pulmonary valve.
For many heart defects, where pulmonary regurgitation is more severe, valve replacement is the best option. It typically means people will need more replacements in the future. Sometimes the pulmonary valve flaps can be repaired instead, and this is considered a first option when possible, as it leaves the valve intact.
Most with a compromised pulmonary valve or one that has been replaced or repaired can live very normal lives in most cases. One major complication that can occur if regurgitation is present or if valve surgery has occurred is that people are much more vulnerable to bacterial endocarditis. This occurs more frequently if people don’t use prophylactic antibiotics before dental work. Except for this issue, many people who also have valve replacements have few restrictions, but underlying conditions like pulmonary hypertension can remain a factor in overall well-being.
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