Pulmonic regurgitation causes

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Pulmonic regurgitation Microchapters


Patient Information


Historical Perspective




Differential diagnosis

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


History and Symptoms

Physical Examination


Chest X-Ray


Cardiac MRI

Severity Assessment


Medical Therapy

Surgical therapy

Follow up

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Aravind Kuchkuntla, M.B.B.S[3], Aysha Aslam, M.B.B.S[4]


A small percentage of pulmonic regurgitation is normal and occasionally murmur can be heard in thin subjects. The most common causes of pulmonary regurgitation are following repair of tetralogy of Fallot and pulmonary stenosis.


The most common causes of pulmonary regurgitation are following repair of tetralogy of Fallot and pulmonary stenosis. Other common causes include as follows:[1][2][3][4]





Chronic PR Acute PR
  • Quadricuspid or Bicuspid valves
  • Hypoplasia of the valves
  • Prolapse of the pulmonary valve
  • Following transannular patching for tetralogy of fallot
  • Following balloon or surgical valvulotomy or valvuloplasty for pulmonary stenosis
  • Absent pulmonary valve syndrome
  • Isolated congenital PR
  • Peripheral pulmonary artery stenosis
  • Pulmonary hypertension
  • Right ventricular outlet aneurysm

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Congenital heart disease, dilated cardiomyopathy, Eisenmenger syndrome, endocarditis, infective endocarditis, myocardial rupture, patent ductus arteriosus, rheumatic heart disease, right ventricular tumors
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cabergoline, ergotamine, fenfluramine, fluoxetine, methysergide, paroxetine, pergolide, phentermine, sertraline
Ear Nose Throat No underlying causes
Endocrine Carcinoid syndrome
Environmental Pneumoconiosis
Gastroenterologic No underlying causes
Genetic Mucopolysaccharidoses, patent ductus arteriosus, polycystic kidney disease, X-linked dilated cardiomyopathy
Hematologic No underlying causes
Iatrogenic Balloon valvuloplasty of the pulmonary valve, cardiac catheterization, cardiopulmonary resuscitation, heart surgery, pacemaker syndrome, percutaneous coronary intervention, prosthetic valve dysfunction, Tetralogy of Fallot repair
Infectious Disease Infective endocarditis, myocarditis, rheumatic fever
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Carcinoid syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Cor pulmonale, idiopathic pulmonary fibrosis, Langerhans cell histiocytosis, pneumoconiosis, pulmonary hypertension, sarcoidosis
Renal/Electrolyte End stage renal disease, polycystic kidney disease
Rheumatology/Immunology/Allergy Rheumatic fever, sarcoidosis
Sexual No underlying causes
Trauma Blunt or penetrating chest trauma
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order


  1. Bacha EA, Scheule AM, Zurakowski D, Erickson LC, Hung J, Lang P; et al. (2001). "Long-term results after early primary repair of tetralogy of Fallot". J Thorac Cardiovasc Surg. 122 (1): 154–61. doi:10.1067/mtc.2001.115156. PMID 11436049.
  2. Jonas SN, Kligerman SJ, Burke AP, Frazier AA, White CS (2016). "Pulmonary Valve Anatomy and Abnormalities: A Pictorial Essay of Radiography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI)". J Thorac Imaging. 31 (1): W4–12. doi:10.1097/RTI.0000000000000182. PMID 26656195.
  3. Ansari MM, Cardoso R, Garcia D, Sandhu S, Horlick E, Brinster D; et al. (2015). "Percutaneous Pulmonary Valve Implantation: Present Status and Evolving Future". J Am Coll Cardiol. 66 (20): 2246–55. doi:10.1016/j.jacc.2015.09.055. PMID 26564602.
  4. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease)". Circulation. 118 (23): 2395–451. doi:10.1161/CIRCULATIONAHA.108.190811. PMID 18997168.
  5. Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J (2009). "Drug-induced fibrotic valvular heart disease". Lancet. 374 (9689): 577–85. doi:10.1016/S0140-6736(09)60252-X. PMID 19683643.
  6. Sharma S, Kirpalani AL, Kulkarni A (2010). "Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis". Ann Pediatr Cardiol. 3 (2): 184–6. doi:10.4103/0974-2069.74055. PMC 3017928. PMID 21234203.
  7. Hendrikx M, Van Dorpe J, Flameng W, Daenen W (1996). "Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature". J Heart Valve Dis. 5 (2): 235–7. PMID 8665020.
  8. Wilke A, Hesse H, Hufnagel G, Maisch B (1997). "Mitral, aortic and tricuspid valvular heart disease associated with ergotamine therapy for migraine". Eur Heart J. 18 (4): 701. PMID 9129909.
  9. Nadrous HF, Pellikka PA, Krowka MJ, Swanson KL, Chaowalit N, Decker PA; et al. (2005). "Pulmonary hypertension in patients with idiopathic pulmonary fibrosis". Chest. 128 (4): 2393–9. doi:10.1378/chest.128.4.2393. PMID 16236900.
  10. Chaowalit N, Pellikka PA, Decker PA, Aubry MC, Krowka MJ, Ryu JH; et al. (2004). "Echocardiographic and clinical characteristics of pulmonary hypertension complicating pulmonary Langerhans cell histiocytosis". Mayo Clin Proc. 79 (10): 1269–75. doi:10.4065/79.10.1269. PMID 15473409.
  11. Bana DS, MacNeal PS, LeCompte PM, Shah Y, Graham JR (1974). "Cardiac murmurs and endocardial fibrosis associated with methysergide therapy". Am Heart J. 88 (5): 640–55. PMID 4420941.
  12. Nelson J, Shields MD, Mulholland HC (1990). "Cardiovascular studies in the mucopolysaccharidoses". J Med Genet. 27 (2): 94–100. PMC 1016928. PMID 2108248.
  13. Pritchett AM, Morrison JF, Edwards WD, Schaff HV, Connolly HM, Espinosa RE (2002). "Valvular heart disease in patients taking pergolide". Mayo Clin Proc. 77 (12): 1280–6. doi:10.4065/77.12.1280. PMID 12479512.
  14. Adeva M, El-Youssef M, Rossetti S, Kamath PS, Kubly V, Consugar MB; et al. (2006). "Clinical and molecular characterization defines a broadened spectrum of autosomal recessive polycystic kidney disease (ARPKD)". Medicine (Baltimore). 85 (1): 1–21. doi:10.1097/01.md.0000200165.90373.9a. PMID 16523049.
  15. Arkles JS, Opotowsky AR, Ojeda J, Rogers F, Liu T, Prassana V; et al. (2011). "Shape of the right ventricular Doppler envelope predicts hemodynamics and right heart function in pulmonary hypertension". Am J Respir Crit Care Med. 183 (2): 268–76. doi:10.1164/rccm.201004-0601OC. PMID 20709819.
  16. Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004). "Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging". J Am Coll Cardiol. 43 (6): 1068–74. doi:10.1016/j.jacc.2003.10.045. PMID 15028368.