7th March 2024

Pulmonary Regurgitation

Any disease of the left side of the heart or the lungs that results in significant pulmonary hypertension and dilated pulmonary arteries may lead to acquired pulmonary regurgitation (PR). PR may also be due to a congenital defect. Acquired PR typically results from surgical repair of Tetralogy of Fallot; pulmonary stenosis, atresia, carcinoid syndrome, rheumatic fever or as a result of infective endocarditis. 

Isolated PR is rarely symptomatic; however, large regurgitant volume in the presence of dilated right ventricle may be associated with exertional dyspnoea, easy fatigability, and intermittent chest pain. 

PR is characterised by an early diastolic murmur along the left sternal border in the second intercostal space with the patient in full inspiration, called a Graham Steell Murmur. This murmur is often heard in patients with chronic cor pulmonale as a result of chronic obstructive pulmonary disease.

Since most PR is secondary to another cause, treatment revolves around treating the underlying cause. Surgical management is rarely required, with the mainstay of treatment being medical management of heart failure.