Pulmonary valve regurgitation

The Pulmonary valve regurgitation is a relatively rare disease of the heart valve, which is usually a symptom of a disease. In very few cases the pulmonary valve insufficiency has to be treated; However, if the disease is severe, surgery is also possible, so that a heart valve replacement is required.

What is pulmonary valve regurgitation?

The medic then speaks of one Pulmonary valve regurgitationif the so-called closure of the pulmonary valve no longer works properly. The heart valve or pulmonary valve is located in the area between the heart and the pulmonary artery. The task of the pulmonary artery is to divert the oxygen-poor 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 is passed on can no longer flow back into the heart. However, if there is pulmonary valve insufficiency, 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 complaints.

causes

In many cases, pulmonary valve insufficiency occurs when the blood pressure in the blood vessels in the lungs is too high. Further reasons for pulmonary valve insufficiency are injuries to the pulmonary valve or inflammation. In the rarest of cases, pulmonary valve insufficiency is congenital.

Inflammation is mainly caused by bacteria. For example, when people who are addicted to drugs inject drugs. Due to the contaminated syringes, it is possible that the bacteria get directly into the vein and from there work their way to the heart valves and trigger an inflammation later.

But there is also the possibility that other diseases trigger pulmonary valve insufficiency. As a further consequence, pulmonary valve insufficiency can also occur due to an advanced course of an underlying disease.

Symptoms, ailments & signs

The so-called primary pulmonary valve insufficiency is often asymptomatic. This means that the patient does not complain of symptoms or complaints; as a result, people live for years with pulmonary valve insufficiency, which remains undetected. However, if there is secondary pulmonary valve insufficiency, different symptoms arise. Above all, exertional dyspnea develops. The person concerned suffers from cyanosis or complains of a significant reduction in performance.

Diagnosis & course of disease

A physical examination is performed as part of the diagnosis. The doctor examines the person affected for peripheral edema or hepatomegaly and also examines the upper 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 sound can also be heard. The doctor then also takes an X-ray of the chest or can determine a significantly enlarged pulmonary artery in the cardio-MRI, which is visible in the right ventricle. Using color Doppler echocardiography, it is possible for the doctor to also assess the extent of the pulmonary valve insufficiency.

The course of the disease depends primarily on the underlying disease of the patient. An exact prognosis can therefore not be given; pulmonary valve regurgitation can also be left untreated and therefore pose no threat to the patient's health or life. In severe cases, the patient has to be operated on, so that there is definitely a risk to life.

For those reasons, it is therefore imperative that the medical professional also diagnose the cause of the pulmonary valve regurgitation; especially since treating the underlying disease is an essential part of therapy.

Complications

Pulmonary valve insufficiency is usually acquired, but in rare cases it can also be caused by a genetic malposition of the heart valve. The majority of genetically caused cases of pulmonary valve insufficiency are almost 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 goes undetected for many years.

Even untreated, the mild pulmonary valve insufficiency does not cause any complications. Performance deficits can only become apparent with greater physical exertion. A different picture emerges with acquired valve insufficiency, which manifests itself in symptoms of varying severity and, if left untreated, can lead to serious complications. Such signs are shortness of breath during exercise and cyanosis, an externally visible blue discoloration of the skin due to a lack of oxygen in the returning venous vessels.

In addition, there is almost always a loss of performance because the right ventricle cannot ensure sufficient blood flow in 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 reduced efficiency of the right heart, peripheral edema can form in the extremities and in the abdomen in the form of ascites.

A pathologically enlarged liver (hepatomegaly) can also be caused by a poor right heart. In order to avoid irreversible consequential damage to the heart valve disease, treatment of the leaky pulmonary valve is recommended in order to combat the cause.

When should you go to the doctor?

Since pulmonary valve insufficiency cannot heal itself and, in the worst case, death of the person affected, this disease must always be treated by a doctor. The earlier this disease is identified and treated, the greater the likelihood of a full recovery. In the case of pulmonary valve insufficiency, a doctor should be consulted if the patient is suffering from severe pain in the heart area. The pain can also spread to the chest.

There is also a reduced performance so that the person concerned can no longer carry out strenuous activities or sports. Cyanosis can also indicate pulmonary valve regurgitation and should always be examined by a doctor. If the symptoms persist over a longer period of time and occur for no particular reason, a doctor should always be consulted immediately.

Pulmonary valve regurgitation must be evaluated 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 usually does not decrease.

Therapy & Treatment

Primary pulmonary valve insufficiency is only treated in very few cases. Probably also because many people do not even know that they suffer from pulmonary valve insufficiency. This is because there are no complaints or symptoms and primary pulmonary valve insufficiency often goes unnoticed for years or is only discovered by chance - as part of a routine examination.

Therapy is therefore usually not required. Especially when the right ventricle of the heart shows an adaptation of the low-pressure volume load. However, if pulmonary hypertension is present, therapy - for example in the form of endocarditis prophylaxis - must be started. But only if the doctor knows what is causing the pulmonary valve insufficiency.

With secondary pulmonary valve insufficiency, however, things are a little different. The doctor primarily deals with the cause before starting treatment. In many cases, the treatment of pulmonary valve insufficiency is a treatment of the underlying disease; In many cases, pulmonary valve insufficiency is only the symptom, so that the pulmonary valve insufficiency does not have to be treated directly, but rather the treatment of the cause is the main focus.

In many cases, if the course of the disease is drastic or if the symptoms and complaints get worse, an operation can help. As part of the surgical treatment, a heart valve replacement is used to remedy the pulmonary valve insufficiency. However, operations only play a major role in very few cases; As a rule, it is a non-treatable disease that only seldom causes problems.

prevention

Pulmonary valve insufficiency can only be prevented to a limited extent. It is advisable to prevent underlying diseases that can trigger pulmonary valve insufficiency. People who are addicted to drugs should therefore ensure that sterile injection sets are used.

If symptoms arise, it is important that a doctor is contacted who can clarify whether it is pulmonary valve insufficiency and what form it is. Especially people who are affected by an underlying disease that can trigger pulmonary valve regurgitation should undergo regular examinations.

Aftercare

Since primary pulmonary valve insufficiency is often only discovered by chance, there is no special therapy or follow-up care for it. However, anyone who notices symptoms such as reduced physical performance, shortness of breath or bluish colored mucous membranes (cyanosis) should immediately consult their doctor or a cardiologist for clarification.

Since secondary pulmonary valve insufficiency is usually the symptom of another underlying disease, the doctor will focus on its treatment. The follow-up care will be adapted accordingly to the underlying disease. However, if the secondary pulmonary valve insufficiency is so severe that a heart valve replacement is necessary, the patient must undergo regular check-ups with a cardiologist.

As part of these examinations, the valve function is checked using echocardiography. The first follow-up should take place around three months after the operation and rehabilitation. Patients with biological valve replacement require anticoagulant therapy (inhibition of blood clotting) up to three months after the operation, but patients with a new mechanical valve for life.

In addition, lifelong endocarditis prophylaxis is necessary before and after operations on the upper respiratory tract and in the oropharynx. Patients in the risk group should also consult a doctor immediately if they have a fever or other signs of an infectious disease. As a rule, those affected are given an endocarditis passport, which contains all the important information and should always be carried with them.

You can do that yourself

Pulmonary valve insufficiency is often symptomatic. This often applies to congenital heart valve defects. Without symptoms of illness, there is of course no need for self-help measures. That changes, however, if the disease is diagnosed by chance after intense physical exertion, which has resulted in shortness of breath or even loss of consciousness. If these symptoms occur, the person concerned should urgently consult a doctor and describe the symptoms.

Once the diagnosis of "pulmonary valve insufficiency" has been made, the doctor will determine the severity of the disease and clarify further treatment options. However, therapy is often not necessary. However, it is the responsibility of the patient to influence the disease process positively through self-help. Regardless of the state of the illness, it is advantageous to gather information or exchange experiences in self-help groups or societies. Many patients with mild heart valve insufficiency can thus be relieved of major fears. Experiences are passed on here as to how in these cases an adapted lifestyle can even strengthen the heart without therapy. Possible solutions are also shown for severe heart defects that require treatment.

Important societies and self-help groups include the "German Society for Cardiology" and the self-help group "German Heart Foundation eV". There the patient is informed extensively and also has the opportunity to exchange experiences with other affected persons. The isolation of the individual patients can be lifted with the help of these self-help groups, thereby improving the general quality of life.