Pulmonic Insufficiency
In pulmonic insufficiency, blood ejected into the pulmonary artery during systole flows back into the right ventricle during diastole, causing fluid overload in the ventricle, ventricular hypertrophy, and eventual right ventricular failure.
Causes
Pulmonic insufficiency may be congenital or may result from pulmonary hypertension. The most common acquired cause is dilation of the pulmonary valve ring from severe pulmonary hypertension.
Rarely, pulmonic insufficiency may result from prolonged use of a pressure monitoring catheter in the pulmonary artery.
Complications
If the patient has pulmonary hypertension, right ventricular failure may develop.
Assessment
The patient may complain of dyspnea on exertion, fatigue, chest pain, and syncope. Peripheral edema may cause him discomfort.
A patient with severe insufficiency that has progressed to right ventricular failure may appear jaundiced, with severe peripheral edema and ascites. He may also appear malnourished.
Auscultation may reveal a high-pitched, decrescendo, diastolic blowing murmur along the left sternal border (Graham Steell’s murmur). This murmur may be difficult to distinguish from the murmur of aortic insufficiency.
Palpation may disclose hepatomegaly when the patient has right ventricular failure.
Diagnostic tests
Cardiac catheterization shows pulmonary regurgitation, increased right ventricular pressure, and associated cardiac defects.
