Pulmonic regurgitation classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pulmonic regurgitation}} | {{Pulmonic regurgitation}} | ||
{{CMG}}{{AE}} {{AKI}}, {{AA}} | {{CMG}}{{AE}} {{AKI}}, {{AA}}, {{JA}} | ||
==Overview== | ==Overview== | ||
[[Pulmonary valve]] [[regurgitation]] may be classified according to [[pulmonary valve]] [[morphology]] and severity of the disease. | [[Pulmonary valve]] [[regurgitation]] may be classified according to [[pulmonary valve]] [[morphology]] and severity of the [[disease]]. Based on the [[pulmonary valve]] [[morphology]], [[PR]] maybe classified into primary and secondary/ functional types. Severity of the [[disease]] may classify into mild, moderate and severe [[disease]]. New York Heart Association's (NYHA) functional classification helps to guage the severity of the [[heart failure]] via physical [[disability]] of the [[patient]]. | ||
==Classification== | ==Classification== | ||
[[Pulmonary valve]] [[regurgitation]] may be classified into the following types based on the [[etiology]] of the [[regurgitation|regurgitant flow]] and severity of the disease:<ref name="ZoghbiAdams2017">{{cite journal|last1=Zoghbi|first1=William A.|last2=Adams|first2=David|last3=Bonow|first3=Robert O.|last4=Enriquez-Sarano|first4=Maurice|last5=Foster|first5=Elyse|last6=Grayburn|first6=Paul A.|last7=Hahn|first7=Rebecca T.|last8=Han|first8=Yuchi|last9=Hung|first9=Judy|last10=Lang|first10=Roberto M.|last11=Little|first11=Stephen H.|last12=Shah|first12=Dipan J.|last13=Shernan|first13=Stanton|last14=Thavendiranathan|first14=Paaladinesh|last15=Thomas|first15=James D.|last16=Weissman|first16=Neil J.|title=Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation|journal=Journal of the American Society of Echocardiography|volume=30|issue=4|year=2017|pages=303–371|issn=08947317|doi=10.1016/j.echo.2017.01.007}}</ref> | [[Pulmonary valve]] [[regurgitation]] may be classified into the following types based on the [[etiology]] of the [[regurgitation|regurgitant flow]] and severity of the disease:<ref name="ZoghbiAdams2017">{{cite journal|last1=Zoghbi|first1=William A.|last2=Adams|first2=David|last3=Bonow|first3=Robert O.|last4=Enriquez-Sarano|first4=Maurice|last5=Foster|first5=Elyse|last6=Grayburn|first6=Paul A.|last7=Hahn|first7=Rebecca T.|last8=Han|first8=Yuchi|last9=Hung|first9=Judy|last10=Lang|first10=Roberto M.|last11=Little|first11=Stephen H.|last12=Shah|first12=Dipan J.|last13=Shernan|first13=Stanton|last14=Thavendiranathan|first14=Paaladinesh|last15=Thomas|first15=James D.|last16=Weissman|first16=Neil J.|title=Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation|journal=Journal of the American Society of Echocardiography|volume=30|issue=4|year=2017|pages=303–371|issn=08947317|doi=10.1016/j.echo.2017.01.007}}</ref> | ||
===Based on the Etiology=== | ===Based on the Etiology=== | ||
[[Pulmonary valve]] regurgitation can be classified into primary and secondary types based on the intrinsic or extrinsic factors involved in the development of the disease: | [[Pulmonary valve]] regurgitation can be classified into primary and secondary types based on the intrinsic or extrinsic factors involved in the development of the disease: | ||
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===Based on the Severity=== | ===Based on the Severity=== | ||
[[Pulmonary valve]] [[regurgitation]] is classified into three categories based on the severity | [[Pulmonary valve]] [[regurgitation]] is classified into three categories based on the severity:<ref name="pmid20620859">{{cite journal| author=Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al.| title=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. | journal=J Am Soc Echocardiogr | year= 2010 | volume= 23 | issue= 7 | pages= 685-713; quiz 786-8 | pmid=20620859 | doi=10.1016/j.echo.2010.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620859 }} </ref><ref name="LancellottiTribouilloy2010">{{cite journal|last1=Lancellotti|first1=P.|last2=Tribouilloy|first2=C.|last3=Hagendorff|first3=A.|last4=Moura|first4=L.|last5=Popescu|first5=B. A.|last6=Agricola|first6=E.|last7=Monin|first7=J. L.|last8=Pierard|first8=L. A.|last9=Badano|first9=L.|last10=Zamorano|first10=J. L.|last11=Sicari|first11=R.|last12=Vahanian|first12=A.|last13=Roelandt|first13=J. R. T. C.|title=European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)|journal=European Journal of Echocardiography|volume=11|issue=3|year=2010|pages=223–244|issn=1525-2167|doi=10.1093/ejechocard/jeq030}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|'''Severity'''}} | ! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|'''Severity'''}} | ||
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===Other Classifications=== | ===Other Classifications=== | ||
*According to 2018 ACHD guidelines, moderate or greater [[pulmonary valve regurgitation]] lies under ''moderate complexity'' according to ACHD (adult congenital heart disease) anatomic and physiological classification.<ref name="StoutDaniels2019">{{cite journal|last1=Stout|first1=Karen K.|last2=Daniels|first2=Curt J.|last3=Aboulhosn|first3=Jamil A.|last4=Bozkurt|first4=Biykem|last5=Broberg|first5=Craig S.|last6=Colman|first6=Jack M.|last7=Crumb|first7=Stephen R.|last8=Dearani|first8=Joseph A.|last9=Fuller|first9=Stephanie|last10=Gurvitz|first10=Michelle|last11=Khairy|first11=Paul|last12=Landzberg|first12=Michael J.|last13=Saidi|first13=Arwa|last14=Valente|first14=Anne Marie|last15=Van Hare|first15=George F.|title=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|journal=Circulation|volume=139|issue=14|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000602}}</ref> | *According to the 2018 ACHD guidelines, moderate or greater [[pulmonary valve regurgitation]] lies under ''moderate complexity'' according to ACHD (adult congenital heart disease) anatomic and physiological classification.<ref name="StoutDaniels2019">{{cite journal|last1=Stout|first1=Karen K.|last2=Daniels|first2=Curt J.|last3=Aboulhosn|first3=Jamil A.|last4=Bozkurt|first4=Biykem|last5=Broberg|first5=Craig S.|last6=Colman|first6=Jack M.|last7=Crumb|first7=Stephen R.|last8=Dearani|first8=Joseph A.|last9=Fuller|first9=Stephanie|last10=Gurvitz|first10=Michelle|last11=Khairy|first11=Paul|last12=Landzberg|first12=Michael J.|last13=Saidi|first13=Arwa|last14=Valente|first14=Anne Marie|last15=Van Hare|first15=George F.|title=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|journal=Circulation|volume=139|issue=14|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000602}}</ref> | ||
*[[Pulmonic regurgitation]] may lead to right and eventually left [[heart failure]]. New York Heart Association's (NYHA) functional classification helps to guage the severity of the [[heart failure]] via physical disability of the [[patient]]. To read more about the NYHA classification [[New york heart association functional classification|click here]]. | *[[Pulmonic regurgitation]] may lead to right and eventually left [[heart failure]]. New York Heart Association's (NYHA) functional classification helps to guage the severity of the [[heart failure]] via physical [[disability]] of the [[patient]]. To read more about the NYHA classification [[New york heart association functional classification|click here]]. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 11:15, 2 August 2020
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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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
Pulmonary valve regurgitation may be classified according to pulmonary valve morphology and severity of the disease. Based on the pulmonary valve morphology, PR maybe classified into primary and secondary/ functional types. Severity of the disease may classify into mild, moderate and severe disease. New York Heart Association's (NYHA) functional classification helps to guage the severity of the heart failure via physical disability of the patient.
Classification
Pulmonary valve regurgitation may be classified into the following types based on the etiology of the regurgitant flow and severity of the disease:[1]
Based on the Etiology
Pulmonary valve regurgitation can be classified into primary and secondary types based on the intrinsic or extrinsic factors involved in the development of the disease:
- Primary pulmonary regurgitation: The pulmonary valve morphology is affected. Isolated PR is very rare and is most commonly associated with other congenital heart diseases.[2]
- Secondary or functional pulmonary regurgitation: The pulmonary valve function is normal. Conditions such as pulmonary hypertension and pulmonary artery aneursym cause dilation of the valve annulus resulting in regurgitation.[3]
Based on the Severity
Pulmonary valve regurgitation is classified into three categories based on the severity:[4][5]
| 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 |
Other Classifications
- According to the 2018 ACHD guidelines, moderate or greater pulmonary valve regurgitation lies under moderate complexity according to ACHD (adult congenital heart disease) anatomic and physiological classification.[6]
- Pulmonic regurgitation may lead to right and eventually left heart failure. New York Heart Association's (NYHA) functional classification helps to guage the severity of the heart failure via physical disability of the patient. To read more about the NYHA classification click here.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.