Pulmonic valvular insufficiency: etiology, recognition, and management

Isolated pulmonary valvular regurgitation: current perspectives

IPVR is a rare clinical entity that was first diagnosed during life in 1955. In the past 35 years, only 69 patients have been reported. With increasing clinical awareness, as well as use of PDE, the confirmation of its clinical diagnosis has become easier and more accurate without having to take recourse to invasive cardiac studies as in the past. For this reason, it is becoming increasingly apparent that IPVR is not so rare as has been suggested in the past. IPVR is more common in men than in women, in whites than blacks, and in the young than the elderly. The mean age of IPVR patients is 27 years (range, 4 to 85). The majority of the patients are asymptomatic and the diagnosis is usually suspected upon the discovery of a crescendo-decrescendo, low-pitched, early to mid diastolic murmur in the second and third left intercostal space, which increases during inspiration, particularly in the presence of a hyperdynamic right ventricle and in the absence of peripheral circulatory phenomenon of aortic regurgitation. The ECG often shows right axis deviation, incomplete right bundle branch block, and rarely, right ventricular hypertrophy and strain. However, a normal ECG does not preclude its diagnosis. Approximately 30% of the IPVR patients have normal 12-lead ECGs. The diagnosis may be further suggested by the posteroanterior chest roentgenogram when dilated and large central pulmonary arteries are noted to pulsate vigorously (hilar dance) on chest fluoroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolated congenital pulmonary incompetence: case report and literature review

Although the literature fails to clearly define the prognosis of isolated congenital pulmonary incompetence (ICPI), there are suggestions that the lesion is not necessarily benign. A case report is presented of pulmonary valve replacement for ICPI which reversed not only symptoms but also electrocardiographic manifestations of right ventricular overload. A literature review is included with the case report.

Effect of mitral regurgitation on the murmur of pulmonic regurgitation

We evaluated auscultatory findings in a 67-year-old man with acquired pulmonic and mitral regurgitation. During inspiration, the murmur of pulmonic regurgitation decreased in intensity prior to surgery, but increased in intensity after mitral valve replacement. Inspiration reduces the volume of mitral regurgitation, thereby reducing the volume and murmur of pulmonic regurgitation.

The diastolic murmur of renal failure

A characteristic and transient early diastolic precordial murmur is commonly heard in patients with renal failure. On the basis of its clinical characteristics, this murmur has previously been attributed to functional aortic incompetence. We undertook a formal cardiac investigation, including aortography, in six of eight patients with renal failure in whom such a bruit developed. Aortic regurgitation was detected in only one of the six. Echocardiography revealed no abnormality of aortic-valve function but did indicate the presence of a small pericardial effusion in each of the five patients examined. We conclude that the early diastolic murmur associated with renal failure does not usually arise from functional aortic incompetence but may be a sound of pericardial origin.

Recurrent aortopulmonary artery fistula

Buxton, B. F., and Cooley, D. A. (1973). Thorax, 28, 521-525. Recurrent aortopulmonary artery fistula. The case report is presented of a patient who underwent successful repair of a recurrent fistula between the aorta and the pulmonary artery secondary to an atherosclerotic aneurysm of the ascending thoracic aorta. The fistula was situated between the proximal part of the ascending aorta and the proximal part of the main pulmonary artery and was associated with aortic incompetence together with pulmonary valvular stenosis and incompetence. The repair involved prosthetic replacement of both the pulmonary and aortic valves, the main pulmonary artery, and the ascending thoracic aorta.