Pulmonary Valve Insufficiency

Definition

Pulmonary valve insufficiency is a disorder involving a defect of the valve located in the pulmonary artery.

Description

This disorder is also known as pulmonary valve regurgitation or pulmonary incompetence. The pulmonary valve is the structure in the pulmonary artery consisting of three flaps, which open and close during each heartbeat. The flaps keep blood from flowing back into the heart from the pulmonary artery—the artery that supplies blood to the lungs. With pulmonary valve insufficiency, the flaps may allow the blood to flow backward, resulting in a distinct murmur. The disorder may be congenital, but also often occurs in patients with severe pulmonary hypertension.

Causes and symptoms

There are generally few to no symptoms with pulmonary valve insufficiency. It may be initially noticed as a murmur in a routine exam of the heart and chest with a stethoscope. The most common causes of the disorder are severe pulmonary hypertension, or the presence of high pressure in the arteries and veins of the lungs. Pulmonary hypertension is usually caused by chronic lung disease, lung blood clots, and sometimes other diseases, such as endocarditis, an inflammation of the lining of the heart and valves. Previous surgery for congenital heart disease may also cause pulmonary valve insufficiency.

Diagnosis

The pitch and location of the murmur will help a physician determine if the cause is pulmonary valve insufficiency. An electrocardiogram (EKG) can detect flow changes. Echocardiography with color Doppler can usually detect regurgitation of blood in the area. This exam is done with ultrasound imaging. A chest x ray may show prominence of the pulmonary artery. In some cases, angiocardiography, or x ray of the arteries and vessels with injection of a dye, may be ordered.

Treatment

On its own, pulmonary valve insufficiency is seldom severe enough to require treatment. Antibiotics are usually recommended before dental work to reduce the possibility of bacterial endocarditis. Management of the primary condition, such as medications to manage pulmonary hypertension, may help control pulmonary valve insufficiency.

Alternative treatment

Since there are few or no symptoms and the disorder is a structural defect, alternative treatment may have only limited usefulness. Proper diet, exercise, and stress reduction may help control hypertension. Coenzyme Q10 and hawthorn (Crataegus laevigata) are two important nutrients to nourish the heart. Antioxidant supplements (including vitamins A, C, and E, selenium, and zinc) can help keep the tissues of the whole body, including the heart, in optimal condition.

Prognosis

Patients with this disorder may never experience limitations from pulmonary valve insufficiency. The disorder may only show up if complicated by pulmonary hypertension. There is an increased incidence of bacterial endocarditis in patients with pulmonary valve insufficiency. Endocarditis can progress rapidly and be fatal.

Prevention

Pulmonary valve insufficiency resulting from chronic lung diseases can be prevented by behaviors and interventions to prevent those primary diseases. Bacterial endocarditis resulting from pulmonary valve insufficiency can usually be prevented with the use of antibiotic prophylaxis in preparation for dental procedures or other procedures which may introduce bacteria into the bloodstream.

BOOKS

Giuliani, Emilio R., et al., eds. Mayo Clinic Practice of Cardiology. 3rd ed. St. Louis: Mosby, 1996.

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.

National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. <http://www.nhlbi.nih.gov>.

Teresa Norris, RN

KEY TERMS

Congenital—Used to describe a condition or defect present at birth.

Endocarditis—Inflammation of the lining of the heart and valves.

Prophylaxis—Preventive. Antibiotic prophylaxis is the use of antibiotics to prevent a possible infection.

Pulmonary—Refers to the lungs and the breathing system and function.

Pulmonary hypertension—High blood pressure in the veins and arteries of the lungs.