Pulmonic regurgitation causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Aravind Kuchkuntla, M.B.B.S[3], Aysha Anwar, M.B.B.S[4]

Overview

A small percentage of pulmonic regurgitation is normal and occasionally a murmur can be heard in thin subjects. The most common causes of pulmonary regurgitation are following repair of tetralogy of Fallot and pulmonary stenosis. In addition, to the physiologic pulmonic regurgitation, the primary causes include an intrinsic pathology in the pulmonic valve. Secondary causes include extrinsic causes. The causes of pulmonic regurgitation can also be reckoned on the basis of the organ systems involved.

Causes

 
 
 
 
 
 
 
 
 
 
 
 
Causes of Pulmonic regurgitation (PR)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physiologic
Mostly found in healthy young people on doppler echo[1][2][3]
 
 
 
 
Primary[4]
 
 
 
Secondary[4]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pulmonary artery dilation
•Right ventricular outlet aneurysm
 
 
 
Pulmonary hypertension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acquired
 
 
 
Congenital
•Quadricuspid or Bicuspid valves
Valvular hypoplasia
pulmonary valveProlapse
Absent pulmonary valve
•Isolated congenital PR
Ebstein’s anomaly (acute PR)
Peripheral pulmonary artery stenosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trauma (usually life-threatening)
Blunt or penetrating chest trauma
Myocardial rupture
 
Infectious/Immune-related
Infective endocarditis (can be life-threatening)
Rheumatic heart disease
 
 
 
 
Tumor/Genetic causes
Carconoid heart disease[5]
Myxomatous degeneration of the pulmonary valve
 
Iatrogenic[6][7][8]
•Post pulmonary valve stenosis repair
• Post TOF transannular patch repair
•Post Blalock-Taussig shunt TOF repair
•Post balloon or surgical valvulotomy or valvuloplasty for pulmonary stenosis (acute PR)
•Perforation of valvular pulmonary atresia (acute PR)
•Medications acting via serotonergic pathways such as ergot derivatives (Pergolide)[9][10]
 

Causes by Organ System[4][5][6][7][8][11]

Cardiovascular Congenital heart disease, dilated cardiomyopathy, Eisenmenger syndrome, endocarditis, infective endocarditis, myocardial rupture, patent ductus arteriosus, rheumatic heart disease, right ventricular tumors
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cabergoline, ergotamine, fenfluramine, fluoxetine, methysergide, paroxetine, pergolide, phentermine, sertraline
Ear Nose Throat No underlying causes
Endocrine Carcinoid syndrome
Environmental Pneumoconiosis
Gastroenterologic No underlying causes
Genetic Mucopolysaccharidoses, patent ductus arteriosus, polycystic kidney disease, X-linked dilated cardiomyopathy
Hematologic No underlying causes
Iatrogenic Balloon valvuloplasty of the pulmonary valve, cardiac catheterization, cardiopulmonary resuscitation, heart surgery, pacemaker syndrome, percutaneous coronary intervention, prosthetic valve dysfunction, Tetralogy of Fallot repair
Infectious Disease Infective endocarditis, myocarditis, rheumatic fever
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Gouty valvular tophi
Obstetric/Gynecologic No underlying causes
Oncologic Carcinoid syndrome
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Cor pulmonale, idiopathic pulmonary fibrosis, Langerhans cell histiocytosis, pneumoconiosis, pulmonary hypertension, sarcoidosis
Renal/Electrolyte End stage renal disease, polycystic kidney disease
Rheumatology/Immunology/Allergy Rheumatic fever, sarcoidosis
Sexual No underlying causes
Trauma Blunt or penetrating chest trauma
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

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