Pulmonic Valve Regurgitation

What is pulmonic valve regurgitation?

Pulmonic valve regurgitation is when the pulmonic valve in your heart doesn’t completely seal between heartbeats. That allows blood to leak the wrong way through the valve.

When the leak is small, it usually doesn’t cause any problems. However, when pulmonic regurgitation is moderate or severe, that can damage the right ventricle and cause right-sided heart failure. Other names for this condition include pulmonic regurgitation, pulmonary valve regurgitation or pulmonary regurgitation.

How does this condition affect my body?

Your heart has four chambers and four valves that manage blood flow through them. The pulmonic valve is the second valve that blood passes through in your heart, and it’s where blood exits the right ventricle. After passing through the pulmonic valve, blood goes through the pulmonary arteries to your lungs, where it picks up oxygen and drops off carbon dioxide.

When you have pulmonic regurgitation, not all of the blood pumped out of the right ventricle goes to your lungs. Some of it flows backward and reenters the right ventricle. That causes the right ventricle to pump harder, trying to compensate and force the extra blood out. Over time, that extra effort stretches and damages the right ventricle and causes right heart failure.

How common is this condition?

Pulmonic regurgitation is extremely common, happening to between 30% and 75% of the population (some sources suggest it’s even higher). However, the leak is almost always too small to cause any symptoms. Most people never know they have it unless they have a test that can detect it.

Moderate to severe pulmonic regurgitation can also happen for many reasons. Because there are so many potential causes, it’s hard to know how commonly the more severe forms of the disease happen.

Who does pulmonic regurgitation affect?

The mildest forms of pulmonic regurgitation happen to people of all ages. The moderate and severe forms tend to happen at different stages of life:

• Young adults: When pulmonic regurgitation happens to young adults, it’s usually because they had a congenital heart condition (a problem they were born with) that they had repaired with surgery earlier in life.
• Older adults: Adults over 75 are more likely to have pulmonary hypertension (high pressure in the lung’s blood vessels). That condition can cause or worsen pulmonic regurgitation.

Symptoms of pulmonic regurgitation

Most people with pulmonic regurgitation have a leak that's too small to cause symptoms. Moderate or severe leaks are more likely to cause symptoms, many of which are similar to those seen with heart failure. These include:

• Shortness of breath (dyspnea).
• Fatigue.
• Feeling dizzy or lightheaded.
• Passing out.
• Heart palpitations.
• Swelling in the abdomen or lower legs and feet.

When you have pulmonic regurgitation along with or because of another condition, you may also have other symptoms. Those symptoms depend on the other condition.

What causes the condition?

There are many potential causes of pulmonic regurgitation. Some of them include:

• Rheumatic heart disease. Untreated bacterial infections can cause rheumatic fever, which can damage your heart’s valves and cause rheumatic heart disease. This is more common in developing countries.
• Pulmonary hypertension. This is high blood pressure in the blood vessels of your lungs. The high pressure on these vessels can extend all the way to where the pulmonary artery exits your heart. That high pressure stretches both the artery and the valve, causing the valve to leak.
• Genetic disorders. Pulmonic regurgitation commonly happens in people with inherited conditions like Marfan syndrome.
• Carcinoid tumors. This uncommon cancer tends to grow slowly and usually starts somewhere in your digestive tract. It can cause carcinoid tissue to build up inside your heart, interfering with blood flow.
• Endocarditis. This is inflammation of the inside lining of your heart. This inflammation happens because of infections. People who need dialysis and permanent ports for intravenous (IV) medications have a higher risk of developing this, and it’s also more common with recreational injectable drug use.
• Injury. In rare cases, injury to your chest can damage your pulmonary valve.
• Congenital problems. A congenital disorder is a problem you have when you’re born. Examples of this include being born with Tetralogy of Fallot (Fallow rhymes with “marshmallow”), without a pulmonary valve or with congenital pulmonic stenosis (an unusually narrow valve).
• Medical procedures. Surgery or other treatments for congenital heart problems like Tetralogy of Fallot or pulmonic stenosis can sometimes lead to pulmonic regurgitation years later.
• Idiopathic. This means that the cause is unknown.

Is it contagious?

Pulmonic regurgitation isn’t contagious. However, it can happen because of contagious infections that spread to your heart or cause rheumatic heart disease.

How is it diagnosed?

Diagnosing pulmonic regurgitation can be tricky, depending on the severity of the problem and your symptoms. It usually involves a combination of a physical examination and diagnostic test imaging. A physical exam usually involves a healthcare provider doing the following:

• Looking: Some of the symptoms of pulmonic regurgitation, like swelling in your belly or lower legs, are visible.
• Feeling: A healthcare provider can feel the swelling on your legs or abdomen as part of this test. They may also have you sit at a certain angle and then press on your belly, looking for a bulge in the jugular veins in your neck. That change happens when your jugular veins are under too much pressure because of problems like pulmonary hypertension.
• Listening: Using a stethoscope, a provider can listen to the sound of your heart. At moderate or severe levels, pulmonic regurgitation causes a heart murmur. These are unusual sounds that happen with your heartbeat because of blood moving in a way it shouldn’t. This is also a way for a provider to catch this condition during a yearly physical (also known as a wellness check) before it causes symptoms.

What tests will be done to diagnose this condition?

The tests you’ll most likely have to diagnose this condition include:

• Electrocardiogram (ECG or EKG).
• Chest X-ray.
• Echocardiogram.

In severe cases, your healthcare provider might request these tests:

• Right heart catheterization.
• Heart magnetic resonance imaging (MRI).

How is it treated, and is there a cure?

Pulmonary regurgitation is usually treatable, and depending on the cause, it’s often possible to cure it. However, it usually doesn’t need treatment unless it’s severe, causes symptoms or both. When it’s severe but isn’t causing symptoms, the goal is to prevent it from getting even worse and causing permanent damage to the right side of the heart.

What medications and treatments are used?

When pulmonary regurgitation happens because of another condition, the first step is usually treating or curing that condition. That often stops the regurgitation or at least reduces the size of the leak, so it causes fewer problems and symptoms.

If that’s not enough to stop the regurgitation, the goal changes to treating it directly. Treating and curing pulmonic regurgitation both involve replacing the valve itself. This can happen in two different ways:

• Surgery. Using this approach, a surgeon can access your heart directly and replace the valve. The replacement valves can come from a human donor or are biosynthetic (a combination of artificial materials and living tissue, usually from pigs or cows).
• Transcatheter pulmonary valve replacement (TPVR). This procedure replaces the valve from the inside using a catheter device. To do this, a healthcare provider makes an incision over a major blood vessel (usually one in your neck or upper thigh) and inserts the catheter. They then steer this long, tube-shaped device up to your heart, where they position the tip over the existing valve. Once there, they expand the new valve, which squashes the old, faulty valve underneath. Replacement valves are usually biosynthetic and last up to 15 years.

Treating this condition also usually involves treating the symptoms causing you the most problems. These medications usually help your body get rid of excess fluid, improve circulation by relaxing blood vessels, or help control or prevent irregular heart rhythms (arrhythmias). Medications can also help your symptoms if you can’t have surgery for any reason, but they can’t cure this condition on their own.

If you have a replacement valve that isn’t biosynthetic, you might need to take blood-thinning medications for the rest of your life. These medications keep your blood from clotting around the valve. That helps prevent or reduce the risk of problems like stroke or pulmonary embolism.

Complications/side effects of the treatment

Treating this condition with TPVR has a high success rate. About 94% to 98% of TPVR procedures are successful. Complications of TPVR are also rare, happening in 3% to 6% of cases (the most common complications are compression of the coronary artery or endocarditis from an infection).

Other possible side effects or complications from these treatments and procedures include:

• Irregular heart rhythms (arrhythmias).
• Infections around the surgery site.
• Leaks around the outside of the valve.
• Needing a replacement for a replacement valve.
• Medication side effects or complications (these are very specific to the medications you take, so your healthcare provider is the best person to tell you more about these).

How to take care of myself/manage symptoms?

Because this condition can look like so many other heart problems — some of which are life-threatening — you shouldn’t try to self-diagnose and treat it. If you suspect you have this problem, you should see a healthcare provider as soon as possible. They can determine if you have this condition and offer you treatment options.

How soon after treatment will I feel better, and how long does it take to recover from this treatment?

The recovery time for this condition depends on the treatment method. Surgery isn’t the most common treatment, and it has the longest recovery time. People who have surgery for pulmonic regurgitation usually take weeks or months to recover. Recovery time for TPVR is much shorter, and you should start to feel better within a few days.

How can I prevent this?

Because pulmonic regurgitation happens unpredictably, preventing it is impossible. This is especially true when it happens because of conditions you had when you were born. All you can do is reduce your risk by avoiding situations or conditions that might cause you to develop it.

How can I reduce my risk?

The only way to reduce your risk of developing pulmonic regurgitation is to avoid infections that can cause it. That means getting any infection, especially ones like strep throat, treated as soon as possible. That prevents the infection from turning into rheumatic heart disease or spreading to and damaging your heart directly.

What’s the outlook for this condition?

Most people with pulmonic regurgitation only have a mild or trace amount of leakage through the valve. For them, the outlook is good, and their lifespan should be the same as people without this condition.

Moderate leakage also usually has a good outlook with early treatment and diagnosis. This is especially true when there’s an underlying cause that’s curable or reversible.

With severe leakage, the outlook depends strongly on how long it takes for them to have it diagnosed and treated. In general, early diagnosis and treatment increase your chances of curing this condition or at least treating it so you can minimize its effects. Your healthcare provider can tell you what your outlook is and what you can do to improve that outlook.

How long does this condition last?

Pulmonary regurgitation is usually a life-long condition unless cured with treatment.

When can I go back to work/school?

Most people who have TPVR only need to stay in the hospital for four or five days, and most can return to work immediately after that. If you have surgery for TPVR, recovery and return to your routine can take weeks or even months. Your healthcare provider is the best person to tell you when you can return to work, school or your regular routine.

Is this condition fatal?

Pulmonic regurgitation isn’t fatal on its own. Instead, it causes other conditions that become life-threatening over time. That’s why early diagnosis and treatment are so important.

How do I take care of myself?

Your healthcare provider is the best person to tell you what you can and should do to manage your symptoms and care for yourself. In general, you should do the following:

• Take your medications. This includes taking your prescription medications as directed, not just when you remember or you don’t feel well.
• See your provider. Your healthcare provider will likely schedule follow-up visits to monitor your condition, even if you don’t have a procedure to repair it. Seeing them as recommended can help catch early signs of complications or problems.
• Don’t push yourself too hard. Your healthcare provider might have you limit your activity. That guidance can help keep you from putting too much strain on your heart, which can make your symptoms or condition worse.
• Pay attention to how you feel. Keeping tabs on your body and symptoms can help you catch early signs of trouble and get treatment before this condition causes permanent problems.

When should I call or see my healthcare provider?

If your symptoms return or change unexpectedly, you should call your healthcare provider. This is especially true when changes happen suddenly or when symptoms start to interfere with your regular routine and activities.

When should I go to ER?

You should go to the hospital if you have any of the following symptoms, which can also happen with heart failure, heart attacks or other dangerous heart problems:

• Shortness of breath (dyspnea).
• Repeated dizzy spells or if you pass out unexpectedly.
• Heart palpitations.
• New swelling in your belly or lower legs and feet.

A note from Cleveland Clinic

Pulmonic regurgitation is a common condition, and for most people, it's not a cause for concern. It can cause symptoms that disrupt your life when it is more severe. If not treated, it can also ultimately lead to serious and even deadly complications. Fortunately, this condition is often treatable — or even curable — and the most common treatment procedures have very high success rates.