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Pulmonic regurgitation

Alexander C Egbe, MD, MPH
Heidi M Connolly, MD, FASE
Section Editor
William A Zoghbi, MD, FASE, FAHA, MACC
Deputy Editor
Susan B Yeon, MD, JD, FACC


Physiologic trace to mild pulmonic valve regurgitation (also known as pulmonic regurgitation or PR) commonly occurs in normal individuals. Greater degrees of PR are caused by various disorders and can lead to right ventricular volume overload and right heart failure.

The causes, clinical manifestations, diagnosis, and treatment of PR are discussed here. Echocardiography of the pulmonic valve is discussed separately. (See "Echocardiographic evaluation of the pulmonic valve and pulmonary artery".)


The etiologies of pulmonic regurgitation (PR) can be classified into physiologic, primary, and secondary causes. Primary causes include iatrogenic, infectious (infective endocarditis), immune-mediated (rheumatic heart disease), systemic (carcinoid disease), and congenital [1-3]. Secondary or functional PR occurs in patients with morphologically normal pulmonic valve who have pulmonary artery dilatation and/or severe pulmonary arterial hypertension [4,5]. (See "Classification and prognosis of pulmonary hypertension in adults" and "Clinical features and diagnosis of pulmonary hypertension in adults".)

Physiologic trivial or mild PR is a common finding on color Doppler echocardiography of normal hearts [6-8].

The most common cause of severe PR is iatrogenic, due to surgical valvotomy/valvectomy or balloon pulmonary valvuloplasty performed for right ventricular outflow tract obstruction as a component of Tetralogy of Fallot (or other conotruncal abnormality) repair [9-12]. Other causes of severe PR include endocarditis and carcinoid. (See "Pathophysiology, clinical features, and diagnosis of tetralogy of Fallot" and "Management and outcome of tetralogy of Fallot" and "Clinical manifestations and evaluation of adults with suspected native valve endocarditis" and "Clinical features of the carcinoid syndrome".)

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Literature review current through: Oct 2017. | This topic last updated: Jul 25, 2017.
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