Pulmonic regurgitation historical perspective

Pulmonic regurgitation Microchapters
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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

Pulmonic regurgitation murmur was first described as Graham-Steell murmur by Dr. Graham Steel in 1888. Before that The pulmonary valve and its function of allowing blood to the lungs for nourishment was first described by Hippocrates. Ibn Nafis then described the pulmonary circulation. Mondino drew a sketch of the pulmonic valve. In 1888 an early blowing diastolic murmur due to pulmonary hypertension was described by Graham-steel, known as Graham-steel murmur. Techniques were then developed to diagnose pulmonary valve regurgitation via the dye method and cardiac catheterization.

Historical perspective

Discovery

• The concept that the cusps of pulmonary valve have the texture different than the ventricles was first described by the father of medicine, Hippocrates (460-377 B.C). The scientist first described that the function of the pulmonary valve is to avoid backflow of blood to the ventricles, ensuring one-way flow through the heart.
• Pulmonary circulation was first described by Ibn Nafis (1210-1288 AD). The book was forgotten until 1924 when the manuscript No.62243 titled Commentary on the anatomy of the Canon of Avicenna was found in Germany.
• The first ever sketch design of the pulmonary valves in their anatomical position was published in a 1541 publication Anatomia Mundini, Ad Vetustis. It was the work of Mondino de Luzzi (1270 A.D -1326 A.D) an Italian physician, anatomist, and professor of surgery in Bologna. He is also known as the Restorer of anatomy. His work also includes describing the course of pulmonary artery (vena arterialis) and pulmonary vein (arteria venalis).

One of the first pictoral representations of the heart anatomy from Mondino Dei Luzzi's Anatomia Mundini, Ad Vetustis, 1541. He described pulmonary artery, pulmonary vein, pleura and lungs in this picture. http://hos.ou.edu/galleries//03Medieval/MondinoDeiLuzzi/1541/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26991959

• Pulmonic regurgitation murmur was first described by Dr. Graham Steel in 1888. Graham-Steell murmur (named after himself) was described in his two publications in Manchester Medical Chronicle. He attributed an early blowing diastolic murmur over and below the pulmonic area to the longstanding pressure in the pulmonary artery, independet of any disease or deformity of the valves. The murmur due to pulmonary hypertension has since been named after the person himself, Graham Steel murmur.
• The term "semilunar" was first used by Galen in 1968 while describing the membranes of the valves in his book De Usu Partium, Volume 1.

Landmark Events in the Development of Diagnosis and Treatment Strategies

• It was long thought that pulmonic regurg can not be diagnosed during the life-time of a patient. In 1956, Ralph F. Morton and Thomas N Stern presented a case of isolated nonsurgical pulmonic regurgitation during the life, suggested by the physical exam, phonocardiography, and fluoroscopy. It was definitively diagnosed by cardiac catheterization.
• Due to the transient, soft nature of the murmur and and resemblance with aortic regurgitation, the need to illustrate the regurgitation by another method arose. In 1958, Wanzer et al. first described the use of Evans blue dye to diagnose the pulmonic valve regurgitation. In 1959, Collins et al. used cardiogreen dye and radioactive krypton (Kr85) to demonstrate the regurg.
• In 1952, Charles A. Hufnagel implanted the first artificial heart valve (caged ball valve, mitral valve) among 10 patients. The implant was a long-term success.
• In 2000, Bonhoeffer et al. reported a first bovine (sheep) transcatheter pulmonic valve repair (tPVR). Abovine jugular venous valve was sewn inside a platinum-iridium stent and then hand-crimped onto a balloon catheter. The device insertion via internal jugular approach was a success with subsequent explantation of the stents.
• In 2000, two months following the initial trial among sheep, again Bonhoeffer et al. reported the first ever successful percutaneous replacement of pulmonary valve in the RV to PA prosthetic conduit via right femoral vein. The recipient 12-year-old male patient with pulmonary atresia and VSD had valve dysfunction post implant at the age of 4 years.

Impact on Cultural History

No significant impact of PR discovery and treatment on cultural history has been reported. There were no outbreaks associated with PR reported in history.

Famous Cases

• Shaun White is an American professional snowboarder. The three-time Olympic champion suffered from TOF and has undergone three separate repair surgeries during hs childhood.
• Jennie Garth, a Hollywood actress mentioned having a heart condition saying: “I have a leaky valve. She also said "I can feel a little weird fluttering." Some literature mentions the actress having mitral regurgitation but it is not clear whether the valvular insufficiency involves pulmonic or mitral valves.