What is pulmonary regurgitation?
When the heart squeezes, the right ventricle (the lower right chamber) pumps blood out into the pulmonary artery. The pulmonary artery then takes the blood to the lungs. The pulmonary valve (sometimes called the pulmonic valve) is located between the right ventricle and the main pulmonary artery. Its job is to prevent blood from leaking back into the heart between beats.
Pulmonary valve regurgitation occurs when the pulmonary valve doesn't completely close and allows some blood to leak back into the heart. This condition is also known as pulmonic regurgitation, pulmonic insufficiency and pulmonary insufficiency. Pulmonary regurgitation can be categorized as mild, moderate or severe.
Signs and symptoms of pulmonary regurgitation
Pulmonary regurgitation often doesn't cause symptoms in infants or children. As the child gets older, though, abnormal signs and symptoms may appear, including:
- Feeling tired
- Fainting with exercise or other activity
- Abnormal heart rhythms
- A heart murmur (an extra heart sound when a doctor listens to the heart with a stethoscope)
Testing and diagnosis of pulmonary regurgitation
We usually diagnose pulmonary regurgitation after a primary care doctor detects a heart murmur and refers a child to the Cardiac Center. Diagnosis may require some or all of these tests:
- Pulse oximetry - a painless way to monitor the amount of oxygen in the blood
- Chest X-ray
- Echocardiogram (also called "echo" or cardiac ultrasound) - sound waves used to see the heart
- Electrocardiogram (ECG) - measures the electrical activity of the heart
- Cardiac MRI - a three-dimensional picture of the heart arteries and veins
- Cardiac catheterization - a thin tube is inserted into the heart through a vein and/or artery in either the leg or through the umbilicus ("belly button")
Treatment for pulmonary regurgitation
Mild pulmonary regurgitation is very common and may not require any treatment. If the pulmonary valve is normal, there may not even be a need for regular checkups. However, if there is moderate or severe pulmonary regurgitation, doctors will monitor the patient with regular checkups.
Currently, medications are not used to help with pulmonary regurgitation itself, but medications may be used to help the heart to pump more efficiently.
In severe cases of pulmonary regurgitation, surgery may be needed to repair or replace the pulmonary valve. Surgeons will consider your child's age, needs and valve anatomy before attempting to repair the valve or improve its function with a surgery called a valvuloplasty.
Another treatment option includes replacing the existing pulmonary valve with an artificial valve, which can be done by a surgeon or cardiologist.
Follow-up care for pulmonary regurgitation
Children with moderate or severe pulmonary regurgitation will require regular checkups with a pediatric cardiologist. At Children’s Hospital of Philadelphia (CHOP), our pediatric cardiologists follow patients until they are young adults and coordinate care with primary care physicians.
Pulmonary regurgitation can cause health problems in adults. It is very important that adults with this condition are monitored by a cardiologist regularly. CHOP’s Cardiac Center can help with the transition to an adult cardiologist.
The Philadelphia Adult Congenital Heart Center, a joint program of CHOP and the University of Pennsylvania, meets the unique needs of adults who were born with heart defects.
Reviewed by Paul Stephens, MD