Pulmonic regurgitation classification

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Pulmonic regurgitation Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X-Ray

Echocardiography

Cardiac MRI

Severity Assessment

Treatment

Medical Therapy

Surgical therapy

Follow up

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

Overview

Pulmonary valve regurgitation (PR) may be classified according to etiology of the regurgitant flow, severity of the disease and chronicity. Based on the etiology of the regurgitant flow, PR may be classified into primary and secondary/ functional types. The severity of the disease may classify into mild, moderate and severe disease. New York Heart Association's (NYHA) functional classification helps to gauge the severity of the heart failure which is a complication of PR. The severity of PR can be assessed by utilizing the American Heart Association and American College of Cardiology (AHA/ACC) staging of valvular heart disease (VHD).

Classification

Pulmonary regurgitation (PR) may be classified into subtypes based on the etiology of the regurgitant flow, severity of the disease and chronicity.[1]

Based on the Etiology

Pulmonary regurgitation (PR) may be classified into two subtypes based on either intrinsic or extrinsic factors involved in the development of the disease:

Based on the Severity

Pulmonary valve regurgitation may be classified into three categories based on the severity of the regurgitant flow:[6][7]

Severity Mild Moderate Severe
Valve morphology Normal Normal to abnormal Abnormal
Symptom status Usually asymptomatic Mild symptoms Significant symptoms
Causes Physiologic PR Secondary causes of PR
(such as pulmonary artery dilation)
Post procedure (such as valvulotomy) or
anatomic abnormalities of the valve


Based on the Chronicity

Pulmonic regurgitation (PR) may be classified into two subtypes based on the chronicity of the disease. Chronic diseases are broadly defined as conditions that last 1 year or more.[8]

Other Classifications

Staging

The staging described is based on 2014 According to the American Heart Association and American College of Cardiology (AHA/ACC) valvular heart disease 2014 guidelines.

Staging of valvular heart disease (VHD)[11]

Staging is based on the progression of the disease. Although the staging has not been specified for PR, it is a useful tool to access the disease course.

Staging of severe PR[12]

Stage Definition Pulmonary Valve

Anatomy

Valve Hemodynamics Hemodynamic Consequences Symptoms
C,D Severe PR
  • Distorted or absent leaflets
  • Annular dilation

References

  1. Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J. (2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 0894-7317.
  2. Chaturvedi RR, Redington AN (2007). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–9. doi:10.1136/hrt.2005.075234. PMC 1994453. PMID 17569817.
  3. Di Lullo L, Floccari F, Rivera R, Barbera V, Granata A, Otranto G; et al. (2013). "Pulmonary Hypertension and Right Heart Failure in Chronic Kidney Disease: New Challenge for 21st-Century Cardionephrologists". Cardiorenal Med. 3 (2): 96–103. doi:10.1159/000350952. PMC 3721135. PMID 23922549.
  4. Frigiola, A.; Giardini, A.; Taylor, A.; Tsang, V.; Derrick, G.; Khambadkone, S.; Walker, F.; Cullen, S.; Bonhoeffer, P.; Marek, J. (2012). "Echocardiographic assessment of diastolic biventricular properties in patients operated for severe pulmonary regurgitation and association with exercise capacity". European Heart Journal - Cardiovascular Imaging. 13 (8): 697–702. doi:10.1093/ehjci/jes002. ISSN 2047-2404.
  5. Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
  6. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K; et al. (2010). "Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography". J Am Soc Echocardiogr. 23 (7): 685–713, quiz 786-8. doi:10.1016/j.echo.2010.05.010. PMID 20620859.
  7. Lancellotti, P.; Tribouilloy, C.; Hagendorff, A.; Moura, L.; Popescu, B. A.; Agricola, E.; Monin, J. L.; Pierard, L. A.; Badano, L.; Zamorano, J. L.; Sicari, R.; Vahanian, A.; Roelandt, J. R. T. C. (2010). "European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)". European Journal of Echocardiography. 11 (3): 223–244. doi:10.1093/ejechocard/jeq030. ISSN 1525-2167.
  8. "About Chronic Diseases | CDC".
  9. 9.0 9.1 DePace, Nicholas L; Nestico, Pasquale F; Iskandrian, Abdulmassih S; Morganroth, Joel (1984). "Acute severe pulmonic valve regurgitation: Pathophysiology, diagnosis, and treatment". American Heart Journal. 108 (3): 567–573. doi:10.1016/0002-8703(84)90425-3. ISSN 0002-8703.
  10. Stout, Karen K.; Daniels, Curt J.; Aboulhosn, Jamil A.; Bozkurt, Biykem; Broberg, Craig S.; Colman, Jack M.; Crumb, Stephen R.; Dearani, Joseph A.; Fuller, Stephanie; Gurvitz, Michelle; Khairy, Paul; Landzberg, Michael J.; Saidi, Arwa; Valente, Anne Marie; Van Hare, George F. (2019). "2018 AHA/ACC Guideline 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 Clinical Practice Guidelines". Circulation. 139 (14). doi:10.1161/CIR.0000000000000602. ISSN 0009-7322.
  11. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.
  12. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.