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Query: UMLS:C0232605 (regurgitation)
 8,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We prospectively assessed the influence of aging on the prevalence of valvular regurgitation by using color flow imaging. One hundred eighteen healthy volunteers (21 to 82 years old) had a two-dimensional Doppler echocardiographic study that included color flow imaging to assess valvular regurgitation and that was semiquantitated by mapping the dimensions of the color flow regurgitant jet in orthogonal views. The subjects were divided into two groups: group 1 consisted of subjects who were younger than 50 years old (n = 61), and group 2 consisted of subjects who were at least 50 years old (n = 57). Mitral regurgitation was detected in 57 (48%) of the 118 subjects: 24 subjects (39%) in group 1 and 33 subjects (58%) in group 2. The severity of mitral regurgitation was trivial to mild. Aortic regurgitation was detected in 13 (11%) of the 118 subjects, all in group 2. The severity was trivial to mild. Tricuspid regurgitation was detected in 77 (65%) of the 118 subjects: 35 (57%) in group 1 and 42 (74%) in group 2. The severity was trivial to mild. Pulmonary regurgitation was detected in 24 (31%) of 78 subjects: nine (22%) in group 1 and 15 (41%) in group 2. The severity was trivial. These findings suggest that valvular regurgitation of a trivial or mild degree is a frequent finding in normal subjects and that it increases with age.
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PMID:Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers. 231 May 93

Between 1958 and 1977, 170 children aged 10 years or less underwent total repair of tetralogy of Fallot at The Johns Hopkins Hospital. Follow-up data were obtained on 128 (90%) of the 143 who survived the operation at 10 to 28 years postoperatively (mean follow-up, 18 years). All patients completed an extensive questionnaire, and 59 returned for a thorough evaluation consisting of a history and physical examination, electrocardiogram, 24-hour Holter monitoring, exercise stress testing, pulmonary function testing, and two-dimensional and Doppler echocardiography. Late survival was excellent with only two of four known late deaths due to cardiac-related causes and with all 59 patients in New York Heart Association class I or II. None had cyanosis or clubbing. Normal sinus rhythm was present in 90%. One patient had complete heart block, and 75% had right bundle-branch block on the electrocardiogram. Right ventricular function was normal by echocardiography in 78%. Residual mild to moderate pulmonary stenosis was noted by Doppler study in 8 patients. Pulmonary regurgitation was present in 78%, but in only 11 patients was it graded as moderate and in none was it severe. Stress testing documented the excellent functional status of most patients, with 92% of predicted exercise time and 94% of maximum heart rate being attained. In the few who had impaired cardiac performance, this correlated best with moderate pulmonary regurgitation. Although the overall late functional status of patients undergoing repair in the first decade of life was very good, these patients need continued follow-up to assess the severity of pulmonary regurgitation and the need of possible intervention.
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PMID:Long-term results of total repair of tetralogy of Fallot in childhood. 238 2

The "absent" pulmonary valve syndrome is associated with aneurysmal dilatation of the pulmonary trunk, stenosis of the ventriculo-arterial junction with or without malalignment of the outlet septum, and ventricular septal defect. When the outlet septum is malaligned, the morphology resembles that of tetralogy of Fallot. We report our experience with 4 infants with this syndrome. All were in severe respiratory distress and cardiac failure when first seen. Cardiac catheterization was performed at 0.5-4.5 months of age in 3 of them. In the other, the clinical and echocardiographic features were considered sufficient to establish the diagnosis. Banding of the pulmonary trunk was carried out at the age of 2.5-5 months. The distal pulmonary arterial pressure in 3 cases dropped to 12-19 mm Hg. These patients could be extubated within one week postoperatively. Their course 1-3 years later is excellent, with rare episodes of mild respiratory problems only and markedly diminished pulmonary insufficiency. One child, weighing 3250 g at surgery, whose pulmonary arterial pressure did not drop below 29 mm Hg, could not be weaned off the respirator. Corrective surgery was undertaken 17 days later, but the patient died of respiratory complications. Based on clinical and Doppler sonographic findings, on control catheterization data and on haemodynamic findings in 3 surviving infants and two further patients with an uneventful course who, as yet, have not undergone surgery, we conclude that the beneficial effect of banding is the combined result of reduced pulmonary arterial pressure and decreased pulmonic regurgitation.
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PMID:Successful palliation of the "absent" pulmonary valve syndrome by banding of the pulmonary trunk. 246 48

Right ventricular volume and ejection fraction were measured in children who had undergone surgical repair for tetralogy of Fallot with excellent results. Fourteen children who had been operated upon at the age of 3 +/- 2.6 years had cardiac catheterization and cineangiography of the right ventricle at the age of 4.6 +/- 2.7 years. Right ventricular volumes were determined from single-plane cineangiography in right anterior oblique projection (Ferlinz method). Eleven children with a normal right ventricle served as controls. Dual projection cineangiography of the pulmonary artery enabled the pulmonary insufficiency to be divided into 4 grades. Echocardiography with colour-coded doppler velocimetry was also performed, showing the absence of residual shunt and of tricuspid, mitral and aortic valve abnormalities. The extension of pulmonary regurgitation flow to the right ventricle was analysed and divided into 4 grades. Pulmonary insufficiency was present in all patients; it was graded 1 or 2 by the two methods in 8 cases (group A) and 3 or 4 by one or the other of the two methods in 6 cases (group B). In 7 patients of group A the operation had included the insertion of a small patch to widen the pulmonary channels (infundibulum alone in 3 cases, transvalvular in 4 cases); in 5 patients of group B a large infundibulo-pulmonary transvalvular patch had been installed. The right ventricular systolic pressure was always below 50 mmHg (mean: 40.9 +/- 6.7 mmHg) and the systolic gradient between right ventricle and pulmonary artery never exceeded 30 mmHg (mean: 14.9 +/- 6.2 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Angiography of right ventricular volume after surgical repair of tetralogy of Fallot]. 250 93

Twenty-five dogs were divided into three experimental groups. In each animal of Group I (10 dogs), one pulmonary valve leaflet was resected and a monocusp-bearing bovine pericardial patch was sewn into the right ventricular outflow tract. The monocusp was retracted to the patch with plicating sutures, and when the sutures were removed the monocusp became functional. In each animal of Group II (10 dogs), an incision was made in the right ventricular outflow tract along the anterior pulmonary valvular commissure and a bovine pericardial patch of adjustable width (one half, one, or one and one half times the diameter of the pulmonary valve ring) was sewn into the incision. Group III (five dogs) was the control group. During each situation of altered pulmonary valve function, in each experimental animal, the pulmonary blood flow and intracardiac pressures were measured. Pulmonary regurgitation was expressed regurgitant fraction (retrograde flow divided by net forward flow). We reached the following conclusions: In all situations where pulmonary incompetence was created, the regurgitant fraction was related directly to the width of the patch and was usually not more than half of the net forward flow when the width of the patch was less than one and a half times the pulmonary valve ring diameter. Regurgitant fraction was about half of net forward flow when one leaflet had been excised. The index of pulmonary artery diastolic pressure minus right ventricular end-diastolic pressure was sensitive and bore an inverse relationship to the degree of pulmonary regurgitation. An accurately placed monocusp-bearing patch restored pulmonary valve competence after excision of a cusp. In treating patients, we are encouraged to preserve as much pulmonary valve function as possible.
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PMID:Pulmonic regurgitation and reconstruction of right ventricular outflow tract with patch. An experimental study. 294 27

Patients with total repair of tetralogy of Fallot may have residual valvular dysfunction, the long-term effect of which is poorly defined. We prospectively studied 59 patients for 18 +/- 5 (mean +/- SD) years postoperatively by Doppler echocardiography and by 24-hour electrocardiographic monitoring. Right ventricular outflow gradients were estimated from the peak continuous-wave Doppler pulmonary artery velocity. The severity of valvular regurgitation was determined by mapping the proximal chamber by pulsed Doppler methods. Right ventricular diastolic cavity area was measured by planimetry of the apical image. The right ventricular outflow tract gradient had a mean value of 9.4 +/- 9.0 mm Hg (range, 0-58 mm Hg; median, 6.6 mm Hg). Pulmonary regurgitation was present in 78% of patients, with 59% of patients graded as mild and 19% as moderate. Tricuspid regurgitation was found in 65% of patients, with 56% of patients graded as mild, 7% as moderate, and 2% as severe. The severity of pulmonary regurgitation correlated with right ventricular cavity area (p less than 0.05). The severity of tricuspid regurgitation was not related to pulmonary stenosis or to the severity of pulmonary regurgitation. Aortic regurgitation is unusual (n = 11) and correlates with aortic root size. The frequency and type of ventricular arrhythmia were not related to the severity of pulmonary stenosis; however, ventricular bigeminy and couplets were related to the severity of pulmonary regurgitation (p less than 0.025). The majority of patients with total repair of tetralogy of Fallot have remarkably good long-term valvular function. For the minority with moderate or severe valvular dysfunction, pulmonary regurgitation is the best marker for ventricular arrhythmias.
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PMID:Long-term valvular function after total repair of tetralogy of Fallot. Relation to ventricular arrhythmias. 318 Mar 93

Pulsed Doppler echocardiography was used to determine prospectively the prevalence of mitral, aortic, tricuspid and pulmonary regurgitation in 80 consecutive patients with mitral valve prolapse and 85 normal subjects with similar age and sex distribution. Mitral valve prolapse was defined by posterior systolic displacement of the mitral valve on M-mode echocardiography of 3 mm or more (40 patients), the presence of one or more mid- or late systolic clicks (61 patients), or both. Mitral regurgitation, detected by pulsed Doppler techniques in 53 patients with prolapse, was holosystolic in 24, early to mid-systolic in 6, late systolic in 15 and both holosystolic and late systolic behind different portions of the valve in 8. Definitive M-mode findings were present in only 27 of the 53 patients, and only 21 had mitral regurgitation audible on physical examination. Tricuspid regurgitation was evident by pulsed Doppler echocardiography in 15 patients (holosystolic in 9, early to mid-systolic in 1, late systolic in 4 and both holosystolic and late systolic in 1); 12 of these 15 patients, including all with an isolated late systolic pattern, had an echocardiographic pattern of tricuspid prolapse, but none had audible tricuspid regurgitation. A Doppler pattern compatible with aortic regurgitation was recorded in seven patients, all without echocardiographic aortic valve prolapse and only two with audible aortic insufficiency. A Doppler shift in the right ventricular outflow tract in diastole, suggestive of pulmonary regurgitation, was recorded in 16 of the 78 patients with an adequate Doppler examination: only 1 of the 16 had audible pulmonary insufficiency. Of the 85 normal subjects without audible regurgitation, pulsed Doppler examination detected mitral regurgitation in 3 subjects (holosystolic in 1 and early to mid-systolic in 2), aortic regurgitation in none, tricuspid regurgitation in 9 (holosystolic alone in 8 and both holosystolic and late systolic in 1) and right ventricular outflow tract turbulence compatible with pulmonary insufficiency in 15. The prevalence of valvular regurgitation, detected by pulsed Doppler echocardiography, is high in patients with mitral valve prolapse. Regurgitation may involve any of the four cardiac valves and is clinically silent in the majority of patients. The prevalence rates of mitral and aortic regurgitation are significantly higher in patients with mitral prolapse than in normal subjects, suggesting that alterations in underlying valve structure in the prolapse syndrome may indeed be responsible for this regurgitation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Pulsed Doppler echocardiographic evaluation of valvular regurgitation in patients with mitral valve prolapse: comparison with normal subjects. 353 60

Twenty nine patients (19 male, mean (SD) age 6.25 (0.5) years (range 0.16-15 years] with typical pulmonary valve stenosis were treated by balloon dilatation of the pulmonary valve. They were studied by echocardiography before the procedure, immediately after it, and at follow up (mean (SD) 10.2 (5.6) months, n = 18). The morphology of the pulmonary valve, the right ventricular-pulmonary artery gradient, and ratio of the systolic to diastolic endocardial dimensions (infundibular ratio) were examined. No patient had pulmonary regurgitation before the study. The valve gradient was significantly reduced (47%) from a mean (SD) of 72 (31) to 37 (23) mm Hg with no short term change in cardiac index after dilatation with a balloon with a mean (SD) diameter that was 118 (10.8)% of the valve annulus. The infundibular ratio was unchanged by the procedure (0.49 (0.11) (n = 21) before dilatation and 0.47 (0.14) (n = 16) after dilatation). In twenty seven patients the commissure of the pulmonary valve was seen to be torn after dilatation. Two patients with bicuspid valves had flail leaflets. Doppler examination at follow up showed mild pulmonary insufficiency in all 29 patients; the mean (SD) valve gradient (31 (+/- 21) mm Hg) at follow up was no different from the gradient found immediately after the procedure and infundibular ratio (0.58 (0.15) was not abnormal. These data indicate that commissural tears are the primary mechanism of valve disruption and demonstrate that the dynamic right ventricular outflow tract obstruction relaxes and gradient reduction persists at follow up.
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PMID:The morphology of the right ventricular outflow tract after percutaneous pulmonary valvotomy: long term follow up. 366 23

Postoperative cardiac catheterization data of 74 patients with pulmonary insufficiency after tetralogy repair were analyzed. Two groups were identified: Group A, 26 patients with normal right ventricular function (ejection fraction 95% +/- 5.5%, end-systolic volume 110% +/- 17% of predicted normal) and Group B, 48 patients with right ventricular dysfunction (ejection fraction 80% +/- 18% [p less than 0.001], and end-systolic volume 218% +/- 75% of predicted normal [p less than 0.001]). There was no significant difference between the two groups with respect to frequency of previous palliative procedures, age at operative repair, operative techniques, methods of myocardial protection, and follow-up period. Right ventricular dysfunction in Group B was associated with significant distal pulmonary stenosis (right ventricle-pulmonary artery pressure gradient 28 +/- 13 torr in Group A versus 55 +/- 20 torr in Group B, p less than 0.001), moderate pulmonary regurgitation (regurgitant fraction 18% +/- 11% in Group A versus 32% +/- 10% in Group B, p less than 0.001), and large transannular outflow patch (ratio of patch diameter to descending aorta diameter 1.31 +/- 0.16 in Group A versus 2.50 +/- 0.28 in Group B, p less than 0.001). Pulmonary valve insertion was performed in 42 patients in Group B. Eighteen had subsequent cardiac catheterization. Right ventricular function recovered completely (end-systolic volume 122% +/- 24%, and ejection fraction 92% +/- 7% of predicted) in five of six patients (83%) who had valve insertion within the first 2 years after tetralogy repair. In contrast, right ventricular function remained abnormal in all 12 patients who had valve insertion later than 2 years after tetralogy repair (p less than 0.05). Patients with residual pulmonary stenosis and/or a large transannular outflow patch are at risk for the development of right ventricular dysfunction from pulmonary insufficiency after tetralogy repair. Early correction of these residual lesions and control of pulmonary insufficiency may prevent long-term deterioration in right ventricular function.
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PMID:Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. Surgical implications. 379 30

Operations for certain congenital cardiac lesions can produce pulmonary regurgitation. Pulmonary regurgitation contributes to right ventricular dysfunction, which may cause early postoperative morbidity and mortality. To ameliorate the problems of pulmonary regurgitation during the early postoperative period, we evaluated a method for its acute control. Complete pulmonary valvectomy was performed utilizing inflow occlusion in eight sheep. A catheter with a 15 ml spherical balloon was positioned in the pulmonary arterial trunk; its inflation and deflation were regulated by an intra-aortic balloon pump unit. Blood flow from the pulmonary arterial trunk and forward and regurgitant fraction were determined from electromagnetic flow transducer recordings. The regurgitant fraction with uncontrolled pulmonary regurgitation was 38% +/- 3% (forward flow = 42 +/- 5 ml/beat and regurgitant flow = 16 +/- 2 ml/beat). Inflation of the balloon during diastole was timed to completely eliminate pulmonary regurgitation. This balloon control of pulmonary regurgitation increased pulmonary arterial diastolic pressure from 12 +/- 1 to 17 +/- 1 mm Hg (p less than 0.0001) and decreased pulmonary arterial systolic pressure from 31 +/- 3 to 27 +/- 1 mm Hg (p = 0.06). Pulmonary arterial pulse pressure decreased from 19 +/- 3 to 9 +/- 1 mm Hg (p less than 0.003). Elimination of pulmonary regurgitation decreased right ventricular stroke volume (25 +/- 3 versus 42 +/- 5 ml/beat, p less than 0.0002) and resulted in a 46% reduction in right ventricular stroke work (5.0 +/- 0.6 versus 9.4 +/- 1.0 gm-m/beat, p less than 0.001) with no change in net forward pulmonary artery flow. Thus, acute pulmonary regurgitation can be controlled and this control improves overall hemodynamic status and decreases right ventricular work.
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PMID:Acute control of pulmonary regurgitation with a balloon "valve". An experimental investigation. 403 77


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