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Pulmonic Regurgitation

Pulmonic Regurgitation. Pulmonic Regurgitation. Incidental benign finding Pathologic PR – usually due to untreated or residual congenital PR. Acquired PR – rare. Usually due to endocarditis, carcinoid syndrome or myxomatous valve disease. Congenital Disease. Thickened deformed leaflets.

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Pulmonic Regurgitation

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  1. Pulmonic Regurgitation

  2. Pulmonic Regurgitation • Incidental benign finding • Pathologic PR – usually due to untreated or residual congenital PR. • Acquired PR – rare. Usually due to endocarditis, carcinoid syndrome or myxomatous valve disease.

  3. Congenital Disease • Thickened deformed leaflets

  4. Endocarditis • Valvular vegetation is present.

  5. Carcinoid • Shortening and thickening of the valve.

  6. Myxomatous Disease • Rare. • Thickened, redundant valve. • Sagging of the leaflet in diastole.

  7. Physiologic PR Physiologic PR • Normal Pulmonic valve • Normal Pulmonary artery • Normal Chamber dimension

  8. Physiologic PR • Normal Pulmonary pressure • PR Jet length < 1 cm • PR Jet duration – not holodiastolic

  9. Borderline PR • PR jet length 1 to 2 cm • PR duration - holodiastolic

  10. Significant PR • PR Jet length > 2 cm • PR duration – holodiastolic

  11. Pulmonic Pressure • SPAP • MPAP • PAEDP

  12. Systolic Pulmonary Artery Pressure • Equals to RVSP in the absence of RVOT obstruction • SPAP = 4 (TR peak velocity)2 + RAP • RAP estimated from IVC

  13. TR – RVSP/SPAP

  14. Mean Pulmonary Artery Pressure MPAP mmHg = 80 – 0.5 x acceleration time (RVOT) MPAP mmHg = 4(PR peak velocity)²

  15. Acceleration Time Acceleration time

  16. Pulmonary Hypertension

  17. Pulmonic Valve - PWD MPAP = 80 – 0.5 x Acceleration Time Normal MPAP = 9 to 18 mmHg

  18. MPAP

  19. Pulmonic - CWD PR – Peak Velocity

  20. Pulmonary Artery End-Diastolic Pressure PAEDP = 4 x (PR end-diastolic velocity)2 + RAP

  21. PR-EDV PR- EDV

  22. Pulmonic Regurgitation

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