Pulmonic regurgitation natural history, complications and prognosis: Difference between revisions
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==Complications== | ==Complications== | ||
Complications which may result from pulmonary regurgitation include:<ref name="pmid17601398">{{cite journal| author=Gregg D, Foster E| title=Pulmonary insufficiency is the nexus of late complications in tetralogy of Fallot. | journal=Curr Cardiol Rep | year= 2007 | volume= 9 | issue= 4 | pages= 315-22 | pmid=17601398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17601398 }} </ref><ref name="pmid12381647">{{cite journal| author=Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J et al.| title=ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation. | journal=Heart | year= 2002 | volume= 88 | issue= 5 | pages= 515-9 | pmid=12381647 | doi= | pmc=1767425 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12381647 }} </ref><ref name="pmid15364855">{{cite journal| author=Frigiola A, Redington AN, Cullen S, Vogel M| title=Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. | journal=Circulation | year= 2004 | volume= 110 | issue= 11 Suppl 1 | pages= II153-7 | pmid=15364855 | doi=10.1161/01.CIR.0000138397.60956.c2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15364855 }} </ref><ref name="pmid20713900">{{cite journal| author=Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J et al.| title=Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. | journal=Circulation | year= 2010 | volume= 122 | issue= 9 | pages= 868-75 | pmid=20713900 | doi=10.1161/CIRCULATIONAHA.109.928481 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20713900 }} </ref> | Complications which may result from [[pulmonary regurgitation]] include:<ref name="pmid17601398">{{cite journal| author=Gregg D, Foster E| title=Pulmonary insufficiency is the nexus of late complications in tetralogy of Fallot. | journal=Curr Cardiol Rep | year= 2007 | volume= 9 | issue= 4 | pages= 315-22 | pmid=17601398 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17601398 }} </ref><ref name="pmid12381647">{{cite journal| author=Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J et al.| title=ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation. | journal=Heart | year= 2002 | volume= 88 | issue= 5 | pages= 515-9 | pmid=12381647 | doi= | pmc=1767425 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12381647 }} </ref><ref name="pmid15364855">{{cite journal| author=Frigiola A, Redington AN, Cullen S, Vogel M| title=Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot. | journal=Circulation | year= 2004 | volume= 110 | issue= 11 Suppl 1 | pages= II153-7 | pmid=15364855 | doi=10.1161/01.CIR.0000138397.60956.c2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15364855 }} </ref><ref name="pmid20713900">{{cite journal| author=Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J et al.| title=Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. | journal=Circulation | year= 2010 | volume= 122 | issue= 9 | pages= 868-75 | pmid=20713900 | doi=10.1161/CIRCULATIONAHA.109.928481 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20713900 }} </ref> | ||
*Progressive right ventricular dilatation | *Progressive [[right ventricular]] dilatation | ||
*Heart failure | *[[Heart failure]] | ||
*Tricuspid regurgitation | *[[Tricuspid regurgitation]] | ||
*Ventricular arrythmias | *Ventricular [[arrythmias]] | ||
*Sudden cardiac death | *[[Sudden cardiac death]] | ||
==Prognosis== | ==Prognosis== | ||
Symptomatic patients are treated with pulmonary valve replacement and have a good prognosis.<ref name="pmid22921969">{{cite journal| author=Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY et al.| title=Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. | journal=J Am Coll Cardiol | year= 2012 | volume= 60 | issue= 11 | pages= 1005-14 | pmid=22921969 | doi=10.1016/j.jacc.2012.03.077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22921969 }} </ref> | Symptomatic patients are treated with pulmonary valve replacement and have a good prognosis.<ref name="pmid22921969">{{cite journal| author=Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY et al.| title=Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement. | journal=J Am Coll Cardiol | year= 2012 | volume= 60 | issue= 11 | pages= 1005-14 | pmid=22921969 | doi=10.1016/j.jacc.2012.03.077 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22921969 }} </ref> | ||
Revision as of 16:00, 31 March 2017
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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]
Overview
Majority of patients with mild PR are asymptomatic and have a benign course, not progressing to chronic PR. Patients tolerate severe chronic PR for a long period of time and begin to develop symptoms when the right ventricle function begins to decline. Chronic severe PR leads to progressive dilation and systolic dysfunction of the right ventricle resulting in symptoms.[1] Complications which may result from pulmonary regurgitation include progressive right ventricular dilatation, heart failure, tricuspid regurgitation, ventricular arrythmias, and sudden cardiac death. Symptomatic patients are treated with pulmonary valve replacement and have a good prognosis.[2]
Natural history
- Mild PR is a very common finding on 2D echo.[1]
- Majority of patients with mild PR are asymptomatic and have a beningn course, not progressing to chronic PR.
- Patients tolerate severe chronic PR for a long period of time and begin to develop symptoms when the right ventricle function begins to decline.
- Chronic severe PR leads to progressive dilation and systolic dysfunction of the right ventricle resulting in symptoms.
- Patients with acute worsening of PR should be evaluated for associated conditions such as pulmonary hypertension which increase the pressure gradient.
Complications
Complications which may result from pulmonary regurgitation include:[3][4][5][6]
- Progressive right ventricular dilatation
- Heart failure
- Tricuspid regurgitation
- Ventricular arrythmias
- Sudden cardiac death
Prognosis
Symptomatic patients are treated with pulmonary valve replacement and have a good prognosis.[2]
References
- ↑ 1.0 1.1 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: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e143–263. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
- ↑ 2.0 2.1 Lee C, Kim YM, Lee CH, Kwak JG, Park CS, Song JY; et al. (2012). "Outcomes of pulmonary valve replacement in 170 patients with chronic pulmonary regurgitation after relief of right ventricular outflow tract obstruction: implications for optimal timing of pulmonary valve replacement". J Am Coll Cardiol. 60 (11): 1005–14. doi:10.1016/j.jacc.2012.03.077. PMID 22921969.
- ↑ Gregg D, Foster E (2007). "Pulmonary insufficiency is the nexus of late complications in tetralogy of Fallot". Curr Cardiol Rep. 9 (4): 315–22. PMID 17601398.
- ↑ Helbing WA, Roest AA, Niezen RA, Vliegen HW, Hazekamp MG, Ottenkamp J; et al. (2002). "ECG predictors of ventricular arrhythmias and biventricular size and wall mass in tetralogy of Fallot with pulmonary regurgitation". Heart. 88 (5): 515–9. PMC 1767425. PMID 12381647.
- ↑ Frigiola A, Redington AN, Cullen S, Vogel M (2004). "Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired tetralogy of Fallot". Circulation. 110 (11 Suppl 1): II153–7. doi:10.1161/01.CIR.0000138397.60956.c2. PMID 15364855.
- ↑ Khairy P, Aboulhosn J, Gurvitz MZ, Opotowsky AR, Mongeon FP, Kay J; et al. (2010). "Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study". Circulation. 122 (9): 868–75. doi:10.1161/CIRCULATIONAHA.109.928481. PMID 20713900.