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Pulmonary Regurgitation

Pulmonary Regurgitation

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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.

  • Mechanical Valve Repair in Children and Teens

    Jonathan Chen, MD: A mechanical valve can be used to replace a damaged or diseased aortic or mitral valve. I'm Jonathan Chen, a surgeon in the Pediatric Heart Valve Center at Children's Hospital of Philadelphia. My team is one of the most experienced in the country in valve repair and replacement. To better understand mechanical valve replacement, let's first take a look at the anatomy of the heart. This is your heart. It has four chambers and four valves.

    The upper chambers are the left atrium and the right atrium. The lower chambers are the left ventricle and the right ventricle. Before entering or leaving each chamber of the heart, blood passes through a valve. The mitral valve is between the chambers on the left side of the heart. The left atrium receives oxygen-rich blood from the lungs and pumps it through the mitral valve to the left ventricle.

    The left ventricle then pumps the blood through the aortic valve and into the aorta, the largest artery in the body. Blood travels from the aorta to blood vessels throughout the body, delivering oxygen and nutrients. Heart valves are made of flaps of tissue called leaflets. The leaflets work like one way doors, opening to let blood move forward, and closing to keep blood from flowing backward. Watch how the leaflets move from another angle, opening to let blood move forward and closing to keep blood from flowing backward.

    The leaflets are attached to a strong tissue called the annulus. The annulus helps maintain the shape of the valve. If a valve is diseased or damaged, it can be surgically removed and replaced with a mechanical valve. A mechanical valve is made of metal and plastic. A thick cloth surrounds the valve. Just like your child's heart valves, the leaflets in the mechanical valve open and close to keep blood flowing through your heart. The mechanical leaflets make a soft clicking noise as they open and close. You can hear it, if you have a mechanical valve. Patients adjust to the sound and are eventually able to ignore it. You might have heard of adults who have bioprosthetic valves, made of tissue from pigs or cows.

    These valves have a high risk of becoming hard over time, in a process called calcification, causing these valves to last less than three to five years in children. During a mechanical valve replacement, your surgeon will remove the diseased or damaged valve and choose the right size replacement valve for your child.

    The surgeon will suture the mechanical valve to the annulus using the sewing ring or cloth rim of the valve. At the Valve Center at Children's Hospital of Philadelphia, our team uses cutting edge imaging to view each patient's heart before surgery. This allows us to develop a highly personalized surgical plan based on your child's unique anatomy.

    In babies and toddlers, a mechanical valve will need to be upsized as your child grows. While a teenager may only need one valve operation, a baby or toddler will likely need two or three re-operations over time. A mechanical valve has an increased risk of infection. It's important to tell your doctor if your child has a serious cut or lesion because they may need antibiotics to prevent infection from traveling to the heart.

    It is possible for scar tissue, called pannus, to grow around the mechanical valve. Too much scar tissue can make it hard for the leaflets to move, requiring a replacement valve. Patients with mechanical valves must take daily blood thinners to prevent clotting on the valve. If a blood clot detaches from the valve and travels to another area of the body, this can be life-threatening. Blood thinning medication needs careful management.

    Dosage must be monitored regularly, which can be done at home. When your child is facing heart valve surgery, we know there are difficult decisions to make. Our experts work together and with you, to make the best decisions for your child before, during, and after surgery.

Transcript Transcript

Follow-up care for pulmonary regurgitation

Through 18

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.

Into adulthood

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.

Why Choose Us

Our specialists are leading the way in the diagnosis, treatment, and research of congenital and acquired heart conditions.

Resources to help

Cardiac Center Resources

We know that caring for a child with a heart condition can be stressful. To help you find answers to your questions – either before or after visiting the Cardiac Center – we’ve created this list of educational health resources.

Reviewed by Paul Stephens, MD

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