Pulmonary valve regurgitation is a relatively rare condition of the heart valve, which is usually a symptom of disease. In very few cases, pulmonary valve regurgitation requires therapy; however, in severe disease, surgery is possible, so a heart valve replacement is needed.
What is pulmonary valve regurgitation?
Doctors speak of pulmonary valve insufficiency when the so-called closure of the pulmonary valve no longer functions properly. The heart valve or pulmonary valve is located in the area between the heart and the pulmonary artery. The function of the pulmonary artery is to drain oxygen-depleted blood directly from the heart and transport it to the lungs. The pulmonary valve can be seen as a valve that ensures that the blood that has been passed on cannot flow back into the heart. However, if pulmonary valve insufficiency is present, it is no longer possible to prevent blood flow. In many cases, a small amount of leakage is normal; that does not cause symptoms or discomfort.
Causes
In many cases, pulmonary valve insufficiency occurs when there is excessive blood pressure in the blood vessels of the lungs. Other causes of pulmonary valve insufficiency include injury to the pulmonary valve or inflammation. In very few cases, pulmonary valve insufficiency is congenital. Inflammation is mainly caused by bacteria. For example, when addicts inject drugs. Because of the contaminated syringe equipment, it is possible for the bacteria to enter the vein directly and work their way from there to the heart valves, triggering an inflammation in the further course. However, there is also the possibility that other diseases trigger pulmonary valve insufficiency. Thus, by extension, pulmonary valve regurgitation may also occur because of advanced disease progression of an underlying condition.
Symptoms, complaints, and signs
So-called primary pulmonary valve regurgitation is often asymptomatic. This means that the patient does not complain of symptoms or discomfort; subsequently, people live for years with pulmonary valve insufficiency, which goes undiagnosed. However, if secondary pulmonary valve regurgitation is present, various symptoms occur. First and foremost, exertional dyspnea develops. The affected person suffers from cyanosis and/or also complains of a significant decrease in performance.
Diagnosis and course of the disease
As part of the diagnosis, a physical examination is performed. The physician examines the affected person for peripheral edema or hepatomegaly and furthermore also examines the upper influence congestion. If there is already pronounced pulmonary valve insufficiency, ascites can sometimes also be diagnosed. During auscultation, it is possible that a widely split second heart sound occurs. Sometimes the Graham-Steell murmur is also perceptible. The physician then takes an X-ray of the chest or can detect a clearly enlarged pulmonary artery on a cardiac MRI, which is visible in the right ventricle. Color Doppler echocardiography also allows the physician to assess the extent of pulmonary valve regurgitation. The course of the disease depends mainly on the patient’s underlying disease. Therefore, an exact prognosis cannot be given; pulmonary valve insufficiency can remain untreated in the same way and thus pose no danger to the patient’s health and life. In severe cases, the patient requires surgery, so there is definitely a threat to life. For those reasons, it is therefore essential that the physician also diagnose the cause of pulmonary valve insufficiency; especially since treatment of the underlying disease is an essential part of therapy.
Complications
Pulmonary valve regurgitation is most commonly acquired, but in rare cases it can be caused by a genetic malformation of the heart valve. The vast majority of genetic cases of pulmonary valve regurgitation are virtually asymptomatic. The slight backflow of blood from the pulmonary artery into the right ventricle during the relaxation phase (diastole) is usually not noticed, so that the insufficiency often remains undetected for a period of many years.Even if left untreated, mild pulmonary valve insufficiency does not cause any complications. Performance deficits may only occur during strenuous physical exertion. Acquired valvular regurgitation presents a different picture, with various severe symptoms that can lead to serious complications if left untreated. Such signs include shortness of breath under exertion and cyanosis, a blue discoloration of the skin visible from the outside due to oxygen deficiency in the returning venous vessels. In addition, there is almost always a loss of performance because the right ventricle cannot provide sufficient blood flow to the lungs due to the backflow of blood from the pulmonary artery. Untreated acquired pulmonary valve regurgitation can lead to serious complications. Due to the decreased efficiency of the right heart, peripheral edema may form in the extremities and abdomen in the form of ascites. An abnormally enlarged liver (hepatomegaly) can also be caused by a right heart with reduced performance. To prevent irreversible sequelae of valvular heart disease, treatment of the leaking pulmonary valve is recommended in the sense of treating the cause.
When should you see a doctor?
Since pulmonary valve insufficiency cannot heal itself and, in the worst case, can lead to the death of the affected person, this disease must always be treated by a doctor. The earlier this disease is detected and treated, the higher the probability of a complete recovery. A doctor should be consulted for pulmonary valve insufficiency if the patient suffers from severe pain in the area of the heart. The pain may also spread to the chest. Likewise, there is reduced performance, so that the affected person can no longer perform strenuous activities or sports. Cyanosis can also indicate pulmonary valve insufficiency and should always be examined by a physician. If the symptoms persist over a long period of time and occur without any particular reason, then a doctor should always be consulted immediately. Pulmonary valve insufficiency must be examined and treated by a cardiologist. Since the disease is usually treated by surgery, a stay in a hospital is necessary. With early treatment, the life expectancy of the affected person is usually not reduced.
Treatment and therapy
Primary pulmonary valve regurgitation is treated only in the fewest cases. Probably also because many people do not even know that they suffer from pulmonary valve insufficiency. This is because there are no symptoms and primary pulmonary valve insufficiency often goes unnoticed for years or is discovered only by chance during a routine examination. As a rule, therefore, no therapy is required. This is especially true if the right ventricle of the heart has an adaptation of the low-pressure volume load. However, if pulmonary hypertension is present, therapy – such as endocarditis prophylaxis – must be started. However, only if the physician also knows what the trigger for the pulmonary valve insufficiency is. In the case of secondary pulmonary valve insufficiency, however, the situation is somewhat different. Predominantly, the physician looks at the cause before starting treatment. In many cases, the therapy for pulmonary valve insufficiency is a treatment of the underlying disease; in many cases, the pulmonary valve insufficiency is merely the symptom, so that the pulmonary valve insufficiency does not have to be treated directly, but the main focus is on treating the cause. In many cases, if the disease progresses drastically or the symptoms and complaints become more severe, surgery can help. As part of the surgical treatment, a heart valve replacement is inserted to correct the pulmonary valve insufficiency. However, surgery plays a supporting role in only a few cases; as a rule, it is a nontherapeutic disease that only rarely causes problems.
Prevention
Pulmonary valve regurgitation can be prevented only to a limited extent. It is advisable that underlying diseases that can trigger pulmonary valve regurgitation be prevented. Persons who are addicted to addictive substances should therefore ensure that sterile injection equipment is used.If symptoms occur, it is important to contact a physician who can clarify whether pulmonary valve insufficiency is present and what form it takes. In particular, people affected by an underlying disease that can trigger pulmonary valve insufficiency should perceive regular examinations.
Follow-up
Because primary pulmonary valve regurgitation is often discovered only as an incidental finding, there is no specific therapy or follow-up for it. However, anyone who notices symptoms such as a reduction in physical performance, shortness of breath, or bluish-colored mucous membranes (cyanosis) should immediately consult their family physician or a cardiologist for clarification. Since secondary pulmonary valve regurgitation is usually a symptom of another underlying disease, the physician will focus on its treatment. Accordingly, follow-up will also be adapted to the underlying disease. However, if the secondary pulmonary valve insufficiency is so severe that valve replacement has become necessary, the patient must undergo regular check-ups with a cardiologist. During these examinations, the valve function is checked by means of echocardiography. The first follow-up should take place approximately three months after surgery and rehabilitation. Patients with a biological valve replacement require anticoagulant therapy (inhibition of blood clotting) for up to three months after surgery, while patients with a new mechanical valve require it for the rest of their lives. In addition, lifelong endocarditis prophylaxis is required before and after upper airway and oropharyngeal surgeries. Patients in the high-risk group should also consult a physician immediately if they develop a fever or other signs of an infectious disease. Usually, those affected are given an endocarditis passport, which contains all important information and should be carried at all times.
What you can do yourself
Pulmonary valve regurgitation often progresses without symptoms. This is often true with congenital valvular defects. Without symptoms of disease, there is, of course, no reason to take self-help measures. This changes, however, if the disease is diagnosed by chance after a severe physical exertion during which shortness of breath or even unconsciousness has occurred. If these symptoms occur, the affected person should first urgently consult a physician and describe the symptoms. Once the diagnosis of “pulmonary valve insufficiency” has been established, the physician will determine the severity of the disease and clarify further therapeutic options. Often, however, therapy is not necessary. However, it is the patient’s own responsibility to positively influence the disease process through self-help. Regardless of the state of the disease, it is beneficial to gather information or exchange experiences within the framework of self-help groups or societies. In this way, many patients with mild valvular insufficiency can already be relieved of great anxiety. Experiences are passed on here as to how, in these cases, it is even possible to strengthen the heart without therapy by means of an adapted lifestyle. Possible solutions are also shown for more severe heart defects requiring treatment. Important societies and self-help groups include the “Deutsche Gesellschaft für Kardiologie” (German Society of Cardiology) or the self-help group “Deutsche Herzstiftung e. V.” (German Heart Foundation). There, the patient receives extensive information and also has the opportunity to exchange experiences with other sufferers. The isolation of individual patients can be lifted with the help of these self-help groups, thereby improving the overall quality of life.
