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Regurgitant Semilunar Valve Disease Pulmonic Regurgitation (PR)
Clinical Presentation: (most of these occur in patients with any cause of right-sided heart failure)
Dyspnea on exertion is most common
Note: In more advanced presentations of right-sided heart failure, abdominal distension secondary to ascites, right
upper quadrant pain secondary to hepatic distension, and early satiety may occur.
Physical Exam: Typical findings:
High-pitched decrescendo murmur along the left sternal border – often indistinguishable from AR
In pulmonary hypertension with PR, P2 is accentuated – with increased RV end-diastolic volume, ejection time is increased, P2 is delayed, and S2 split is widened.
Jugular venous pressure: usually increased; increased “a” wave is often present
Palpation: RV systolic pulsation sometimes noted at the left lower sternal border due to RV enlargement;
palpable pulmonary artery pulsation at left upper sternal border if patient has significant pulmonary artery dilatation
PR most commonly develops in setting of severe pulmonary hypertension and results from dilatation of the
valve ring by the enlarged pulmonary artery.
Incompetence of the pulmonic valve occurs is caused three pathologic processes:
dilatation of the pulmonic valve ring
acquired alteration of pulmonic valve cusp morphology
congenital absence or malformation
If have PR with pulmonary hypertension, can see: prominent central pulmonary arteries w/ enlarged hilar vessels and loss of vascularity in peripheral lung fields ("pruning")
Echocardiography: Doppler echocardiography can easily identify between AR and PR – as their murmurs sound
the same and can be indistinguishable.
Electrocardiogram: may show right axis deviation due to RVH; can also show RA dilation if back-up is
PR seldom severe enough to warrant special treatment because RV normally adapts to low-pressure volume
overload without difficulty.