Valvular Regurgitation - Pulmonic Insufficiency

Murmur characteristics

• Low pitched

• Diastolic

• Increased with inspiration

PI murmur is called a

Graham Steel Murmur (Board question)

systolic murmurs are heard when there’s regurgitation with

Atrioventricular valves

diastolic murmurs are heard when there’s regurgitation with

Semilunar valves

Acute regurgitation always results in

pressure overload

Etiology (causes) 6

• Pathologic PI is not frequent

• MOST COMMONLY caused by pulmonary HTN

  • Leads to Annular dilation

• Endocarditis

• Rheumatic Heart Disease

• Tetralogy of Fallot

• Carcinoid

% of people with normal PI

40-87%

Pathologic PI

NOT FREQUENT

• This valve usually doesn’t have a lot of problems

Why is it difficult to see the valve cusps on a 2D echo

Pulmonic valve leaflets are very thin

Pulmonic insufficiency directed towards the Tricuspid leaflet causes:

Diastolic fluttering on M-Mode

RV Volume overload on M-Mode causes (2)

RV Enlargement and paradoxical septal motion

Evaluate _______ & ________ of the PI Color doppler jet

EXTENT & AREA

Assess CW Spectral doppler jet _______ for _______

assess CW spectral doppler jet DENSITY for SEVERITY

Severe PI causes

Rapid equalization of RV and Pulmonary artery pressures

Regurgitation for PI is above the baseline and SEVERE PI IS DAGGER SHAPED

• Rapid reversal

• rapid desceleration

• BAD BAD BAD!